Lidocaine (40 mg/2ml)
Max: Concentration : 20 mg/ml
Solution : NSS, D5W
Dosing instruction: Bolus 1-1.5 mg/kg over 2-3 mins (average 50-100 mg)
repeat dose 0.5-0.75 mg/kg in 3-5 min up to 3 mg/kg total
Loading dose (lean body weight)
Body Weight
kg.
Height
cm.
Sex
Lean Body Weight
kg.
Lean body weight (Janmahasatian)
Male: LBW = (9270 x TBW)/(6680+(261 x BMI))
Female: LBW = (9270 x TBW)/(8780+(244 x BMI))
Bolus dose 50 - 75 mg i.v.
Repeat dose 25 - 37 mg i.v.
Infusion chart: Lidocaine Hydrochloride
Dose | Lidocaine 2000mg+ NSS or D5W up to 250 ml | Lidocaine 1000mg + NSS or D5W up to 250 ml |
|---|---|---|
1 mg/min | 7.5 ml/h | 15 ml/h |
2 mg/min | 15 ml/h | 30 ml/h |
3 mg/min | 22.5 ml/h | 45 ml/h |
4 mg/min | 30 ml/h | 60 ml/h |
Weight descriptors for dose adjustment of ICU drugs in obese patients
Group | Drug | Recommended Dosing |
|---|---|---|
Analgesic | Fentanyl | LBW [1] |
Morphine | LBW [1] | |
Sedative | Dexmedetomidine | LBW [2] |
Midazolam | LD: TBW, MD: LBW [3] | |
Propofol | LD: LBW, MD: TBW [1] | |
Vasopressor & Inotropic | Dobutamine | IBW [7] |
Dopamine | IBW [7] | |
Epinephrine | IBW [7] | |
Levosimendan | TBW [8] | |
Milrinone | TBW [7] | |
Norepinephrine | IBW [7] | |
Beta-blocker | Esmolol | TBW [4] |
Labetalol | IBW [6] | |
Anti-arrhythmic | Lidocaine | LBW [5] |
Neuromuscular Blocking agent | Atracurium | IBW [1] |
Cisatracurium | IBW [1] | |
Anticoagulant | Enoxaparin | TBW [7] |
TBW: True body weight, LBW: Lean body weight, IBW: Ideal body weight, LD: loading dose, MD: maintenance dose
References
1) Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
2) Rolle A, Paredes S, Cortínez LI, Anderson BJ, Quezada N, Solari S, Allende F, Torres J, Cabrera D, Contreras V, Carmona J, Ramírez C, Oliveros AM, Ibacache M. Dexmedetomidine metabolic clearance is not affected by fat mass in obese patients. Br J Anaesth. 2018 May;120(5):969-977. doi: 10.1016/j.bja.2018.01.040. Epub 2018 Mar 28. PMID: 29661414.
3) Bian L. Critical Care Pharmacotherapy. 1 st ed. the United States of America: American College of Clinical Pharmacy; 2016.
4) Kane-Gill S, Dasta J, editors. High-Risk IV Medications in Special Patient Populations [Internet]. London: Springer London 2011 [cited 2025 May 8] Available from: https://link.springer.com/book/10.1007/978-0-85729-606-1
5) Tognolini AR, Liu X, Pandey S, Roberts JA, Wallis SC, Jackson D, Eley VA. Dosing optimisation of intravenous lidocaine in patients with class 1-3 obesity by population pharmacokinetic analysis. Anaesthesia. 2025 May;80(5):511-521. doi: 10.1111/anae.16531. Epub 2025 Jan 2. PMID: 39745506.
6) Cheymol G, Poirier JM, Carrupt PA, Testa B, Weissenburger J, Levron JC, Snoeck E. Pharmacokinetics of beta-adrenoceptor blockers in obese and normal volunteers. Br J Clin Pharmacol. 1997 Jun;43(6):563-70. doi: 10.1046/j.1365-2125.1997.00609.x. PMID: 9205815; PMCID: PMC2042788.
7) Erstad BL, Barletta JF. Drug dosing in the critically ill obese patient: a focus on medications for hemodynamic support and prophylaxis. Crit Care. 2021 Feb 23;25(1):77. doi: 10.1186/s13054-021-03495-8. PMID: 33622380; PMCID: PMC7901103.
8) Simdax. Simdax SPC [Internet] 2021 [Cited 08 May 2025]. Available from: https://www.simdax.com/siteassets/simdax-spc.pdf