Lignocaine

LIGNOCAINE

Q. 1 Dose of lignocaine for spinal anesthesia is?
 A 0.5%
 B

2.5%

 C 4%
 D 5%
Q. 1 Dose of lignocaine for spinal anesthesia is?
 A 0.5%
 B

2.5%

 C 4%
 D 5%
Ans. D

Explanation:

5% REF: Morgan’s 4th e p. 270, KDT 6th edition page 357 Concentration of lignocaine can be remembered as “INETS”

IV regional anesthesia

0.5%

Nerve block

1%

Epidural / jelly

2%

Topical

4%

Spinal

5%


Q. 2

Dose of lignocaine for spinal anesthesia is `)/0 of:

 A 5
 B 25
 C 50
 D 75
Q. 2

Dose of lignocaine for spinal anesthesia is `)/0 of:

 A 5
 B 25
 C 50
 D 75
Ans. A

Explanation:

5%


Q. 3

Maximum safe dose of lignocaine with adrenaline is:

 A 3 mg/kg wt.
 B 7 mg/kg wt
 C 10 mg/kg wt.
 D 15 mg/kg wt
Q. 3

Maximum safe dose of lignocaine with adrenaline is:

 A 3 mg/kg wt.
 B 7 mg/kg wt
 C 10 mg/kg wt.
 D 15 mg/kg wt
Ans. B

Explanation:

7 mg/kg wt


Q. 4

Maximum safe dose of lignocaine for spinal anesthesia is

 A 5-15 mg
 B 25-100 mg
 C 100-200 mg
 D 150-300 mg
Q. 4

Maximum safe dose of lignocaine for spinal anesthesia is

 A 5-15 mg
 B 25-100 mg
 C 100-200 mg
 D 150-300 mg
Ans. B

Explanation:

25-100 mg


Q. 5

Which of the following concentration of lignocaine is used in epidural anaesthesia?

 A

5%

 B

0.5%

 C

2%

 D

4%

Q. 5

Which of the following concentration of lignocaine is used in epidural anaesthesia?

 A

5%

 B

0.5%

 C

2%

 D

4%

Ans. C

Explanation:

1-2% lignocaine with or without adrenaline is used in epidural anaesthesia.

Lignocaine in the concentration of 0.5 – 1 % is used for local infiltration anaesthesia.

For surface application 4% lignocaine is used as a liquid or 5% as a gel.

Reference:
Textbook of Anaesthesia for Post Graduates By T.K Agasti, page 337


Q. 6

What is the maximum dose of lignocaine which can be given with adrenaline for ocular blocks?

 A

2 mg/kg

 B

3 mg/kg

 C

5 mg/kg

 D

7mg/kg

Q. 6

What is the maximum dose of lignocaine which can be given with adrenaline for ocular blocks?

 A

2 mg/kg

 B

3 mg/kg

 C

5 mg/kg

 D

7mg/kg

Ans. D

Explanation:

In the injectable form, maximum dose of lignocaine which can be given alone is 5mg/kg.

When combined with epinephrine 1: 200,000, maximum dose which can be used is 7mg/kg.

Maximum dose of topical lidocaine is 4.5mg/kg upto 300mg.


Q. 7

A patient undergoing a minor surgical procedure is given lignocaine injection.

Assertion: Local anaesthetics acts by blocking nerve conduction. 

Reason: Small fibers and non myelinated fibers are blocked more easily than large myelinated fibers.

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 7

A patient undergoing a minor surgical procedure is given lignocaine injection.

Assertion: Local anaesthetics acts by blocking nerve conduction. 

Reason: Small fibers and non myelinated fibers are blocked more easily than large myelinated fibers.

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. B

Explanation:

Local anaesthetics blocks nerve conduction by decreasing the entry of sodium ions during upstroke of action potential.

Finally it blocks depolarization to reach threshold potential and conduction block occurs.

Small fibers are more sensitive to local anaesthetics than large fibers and non myelinated fibers are blocked easily than myelinated fibers.

Ref: Essentials of Medical Pharmacology by K D Tripathi, 5th Edition, Pages 321-3


Q. 8

Lignocaine is used as anesthetic and class IB antiarrhythmic. Which of the following are the preparations available for lignocaine?

 A

0.5%jelly, 1 % injection

 B

1% jelly, 2% injection

 C

2% jelly, 4% injection

 D

4% jelly, 5% injection

Q. 8

Lignocaine is used as anesthetic and class IB antiarrhythmic. Which of the following are the preparations available for lignocaine?

 A

0.5%jelly, 1 % injection

 B

1% jelly, 2% injection

 C

2% jelly, 4% injection

 D

4% jelly, 5% injection

Ans. C

Explanation:

Preparations of lignocaine:
  • Inj local: 0.5, 1, 1.5, 2, 4, 10, 20%.
  • Inj IV: 1% (10 mg/mL), 2% (20 mg/mL); admixture 4, 10, 20%.
  • IV inf: 0.2%, 0.4%; cream 2%; gel 2, 2.5%; oint 2.5, 5%; liq 2.5%; soln 2, 4%; viscous 2%
 
Ref: Gomella L.G., Haist S.A. (2007). Chapter 22. Commonly Used Medications. In L.G. Gomella, S.A. Haist (Eds), Clinician’s Pocket Reference: The Scut Monkey, 11e.

Q. 9

What is the concentration of lignocaine used for topical anaesthesia?

 A

2%

 B

2-10%

 C

7-12 %

 D

12-15%

Q. 9

What is the concentration of lignocaine used for topical anaesthesia?

 A

2%

 B

2-10%

 C

7-12 %

 D

12-15%

Ans. B

Explanation:

Anesthesia of mucous membranes of the nose, mouth, throat, tracheobronchial tree, esophagus, and

genitourinary tract can be produced by direct application of aqueous solutions of salts of many local anesthetics or by suspension of the poorly soluble local anesthetics.

Tetracaine (2%), lidocaine (2-10%), and cocaine (1-4%) typically are used.

Maximal safe total dosages for topical anesthesia in a healthy 70-kg adult are 300 mg for lidocaine, 150 mg for cocaine, and 50 mg for tetracaine.

Ref: Catterall W.A., Mackie K. (2011). Chapter 20. Local Anesthetics. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12e.


Q. 10

High first pass metabolism is seen in –

 A

Lignocaine

 B

Propranolol

 C

Salbutamol

 D

All

Q. 10

High first pass metabolism is seen in –

 A

Lignocaine

 B

Propranolol

 C

Salbutamol

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., Lignocaine; ‘b’ i.e., Propranolol; ‘c’ i.e., Salbutamol


Q. 11

Lignocaine is used in –

 A

Atrial fibrillation

 B

Atrial flutter

 C

PSVT

 D

Ventricular tachycardia

Q. 11

Lignocaine is used in –

 A

Atrial fibrillation

 B

Atrial flutter

 C

PSVT

 D

Ventricular tachycardia

Ans. D

Explanation:

Ans. is ‘d’ i.e., Ventricular tachycardia

o Lidocaine is used principally for ventricular arrhythmia, especially those complicating myocardial infarction.
o Lidocaine is DOC for digitalis induced ventricular arrhythmias.


Q. 12

Best used in digoxin induced arrhythmia-

 A

Phenytoin

 B

Lignocaine

 C

Quinidine

 D

Procainamide

Q. 12

Best used in digoxin induced arrhythmia-

 A

Phenytoin

 B

Lignocaine

 C

Quinidine

 D

Procainamide

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lignocaine

o Lignocaine is DOC for digitalis induced ventricular arrhythmias.
o Phenytoin is an alternative.


Q. 13

Drug of choice in lignocaine toxicity

 A

Bretylium

 B

Amiodarone

 C

Isoprenaline

 D

Diazepan

Q. 13

Drug of choice in lignocaine toxicity

 A

Bretylium

 B

Amiodarone

 C

Isoprenaline

 D

Diazepan

Ans. D

Explanation:

Ans. is `d’ i.e., Diazepan

o If lignocaine toxicity is suspected, stop the injection immediately.

o Ensure adequate oxygenation, whether by face mask or by intubation.

o Anticonvulsants such as benzodiazepines and barbiturates are the drug of choice for seizure control. o Succinylcholine is sometimes also used to terminate the neuromuscular effects of seizures.

o If CVS symptoms occur (cardiac depression and hypotension), IV fluid and vasopressor agents may be required.

o If metabolic acidosis develops, use of sodium bicarbonate can be considered, although, as in other instances of acute metabolic acidosis, this is controversial.


Q. 14

Lignocaine can be used in all except –

 A

Ventricular fibrillation

 B

Spinal anaesthesia

 C

Epidural anaesthesia

 D

Convulsions

Q. 14

Lignocaine can be used in all except –

 A

Ventricular fibrillation

 B

Spinal anaesthesia

 C

Epidural anaesthesia

 D

Convulsions

Ans. D

Explanation:

Ans. is ‘d’ i.e., Convulsion

o Lidocaine can be used in surface anaesthesia, infiltration anaesthesia, conduction block, spinal anaesthesia, epidural anaesthesia, intravenous regional anaesthesia (intravasular infiltration anaesthesia) and in arrhythmias (ventricular tachyarrhythmias).


Q. 15

Local anaesthetic used as an antiarrhythmic agent is –

 A

Bupivacaine

 B

Lignocaine

 C

Cocaine

 D

Chlorprocaine

Q. 15

Local anaesthetic used as an antiarrhythmic agent is –

 A

Bupivacaine

 B

Lignocaine

 C

Cocaine

 D

Chlorprocaine

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lignocaine


Q. 16

A patient selected for surgery was induced with Thiopentone iv through one of anti cubital vein complains of severe pain of whole hand. The next line of management

 A

Give IV propofol through same needle

 B

IV ketamine through same needle

 C

IV lignocaine through same needle

 D

Leave it done

Q. 16

A patient selected for surgery was induced with Thiopentone iv through one of anti cubital vein complains of severe pain of whole hand. The next line of management

 A

Give IV propofol through same needle

 B

IV ketamine through same needle

 C

IV lignocaine through same needle

 D

Leave it done

Ans. C

Explanation:

C i.e. IV lignocaine through same needle


Q. 17

True about local anaesthetic

 A

Cocaine acts by decreasing norepinephrine

 B

Act by decreasing sodium entry into cell

 C

Lignocaine is a amide

 D

b and c

Q. 17

True about local anaesthetic

 A

Cocaine acts by decreasing norepinephrine

 B

Act by decreasing sodium entry into cell

 C

Lignocaine is a amide

 D

b and c

Ans. D

Explanation:

B i.e. Act by decreasing sodium entry into cell; C i.e. Lignocaine is amide


Q. 18

Concentration of lignocaine used

 A

2%

 B

4%

 C

5%

 D

All

Q. 18

Concentration of lignocaine used

 A

2%

 B

4%

 C

5%

 D

All

Ans. D

Explanation:

A i.e., 2% B i.e., 4% C i.e., 5% 


Q. 19

Lignocaine in high dose produces

 A

Convulsion

 B

Respiratory depression

 C

Hypotension

 D

All

Q. 19

Lignocaine in high dose produces

 A

Convulsion

 B

Respiratory depression

 C

Hypotension

 D

All

Ans. D

Explanation:

A i.e. Convulsion; B i.e. Respiratory depression; C i.e. Hypotension

Xylocaine is available in concentration of 5% (for subarachnoid-spinal anesthesia), 4% (topical) and .2% (2, 1.5, 1 and 0.5%) of which 0.5% is usually used for epidural.

If it is asked that what is the max dose of Xylocaine with adrenaline the answer will be same i.e. 500 mgQ and ans. will be 300 mgQ when max dose of lignocaine without adrenaline is asked.

Lidocaine is an amide and can l/t convulsions, bronchospasm, respiratory failure, depress hypoxia drive, and can cause apnea, bradycardia, hypotension & cardiac failureQ.


Q. 20

A patient was admitted epidural anaesthesia with 15 ml of 1.5%. Lignocaine with adrenaline for hernia surgery. He devoled hypotension and respiratory depression within 3 minutes after administration of block. The most common cause would be:

 A

Allergy to drug administered

 B

Systemic toxicity to drug administered

 C

Patient got vasovagal shock

 D

Drug has entered the subarachnoid space

Q. 20

A patient was admitted epidural anaesthesia with 15 ml of 1.5%. Lignocaine with adrenaline for hernia surgery. He devoled hypotension and respiratory depression within 3 minutes after administration of block. The most common cause would be:

 A

Allergy to drug administered

 B

Systemic toxicity to drug administered

 C

Patient got vasovagal shock

 D

Drug has entered the subarachnoid space

Ans. D

Explanation:

D i.e. Drug has entered the sub arachnoid space


Q. 21

Adrenaline is added to Lignocaine injection for:

March 2007

 

 A

Less bleeding at the site

 B

Higher doses can be given

 C

Prolonged duration of action

 D

All of the above

Q. 21

Adrenaline is added to Lignocaine injection for:

March 2007

 

 A

Less bleeding at the site

 B

Higher doses can be given

 C

Prolonged duration of action

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above

Adrenaline is a local vasoconstrictor, so using adrenaline only with short acting agents such as Lignocaine has advantages, like:

  • Less bleeding at the site (local infiltration).
  • Less systemic absorption, and consequently lower toxicity and possibility of giving a higher dose.
  • Prolonged duration of action.

Q. 22

About lignocaine, all are true except ‑

 A

It is ester group of local anaesthetic

 B

It has antiarrhythmic property

 C

Can penetrate through mucous membrane

 D

It can precipitate malignant hyperthermia

Q. 22

About lignocaine, all are true except ‑

 A

It is ester group of local anaesthetic

 B

It has antiarrhythmic property

 C

Can penetrate through mucous membrane

 D

It can precipitate malignant hyperthermia

Ans. A

Explanation:

Ans. is ‘a’ i.e., It is ester group of local anaesthetic

Lidocaine

  • It is the most commonly used local anaesthetic.
  • It also has antiarrhythmic property.
  • Systemic toxicity is less than bupivacaine. CNS involvement occurs at much lesser dose than CVS involvement.
  • It can precipitate malignant hyperthermia –> should not be used in these patients.
  • For regional anaesthesia, it is used in different concentraions for different type of anaesthesia Surface (topical) analgesia : 4%, nerve block : 1 – 2%, Spinal anaesthesia : 5%, Epidural : 1 – 2 %, Beir’s block (intravenous regional anaesthesia) : 0.5% and infiltration block : 1 – 2%.
  • Maximum safe dose of lidocaine wihout adrenaline is 300 mg (4.5 mg/kg) and with adrenaline is 500 mg (7 mg/kg).
  • Besides local anaesthesia lidocaine is used : –
  • To treat ventricular arrhythmias.
  • To blunt the cardiovascular response to laryngoscopy and intubation, (i.v. or intrathecal administered lidocaine).

Q. 23

Percentage of adrenaline with lignocaine for local infilteration is‑

 A

1:1000

 B

 1:10000

 C

 1:100

 D

1:50000

Q. 23

Percentage of adrenaline with lignocaine for local infilteration is‑

 A

1:1000

 B

 1:10000

 C

 1:100

 D

1:50000

Ans. D

Explanation:

Ans. is ‘d’ i.e., 1:50000 

  • The most common concentrations of epinephrine combined with local anaesthetics are 1:50,000 (0.02 mg/ml), 1:100,000 (0.01 mg/ml) and :200000 (0.005 mg/ml).
  • The 1:50000 concentration is manufactured in combination with 2% lidocaine.
  • The 1:100,000 concentration is manufactured in combination with 2% lidocaine and 4% articaine.
  • The 1:200,000 concentration is manufacture in combination with 4% prilocaine, 4% articaine and 0.5% bupivacaine

Q. 24

Drug of choice for lignocaine toxicity ‑

 A

Phenytoin

 B

Phenobarbitone

 C

Beta-blockers

 D

Amiodarone

Q. 24

Drug of choice for lignocaine toxicity ‑

 A

Phenytoin

 B

Phenobarbitone

 C

Beta-blockers

 D

Amiodarone

Ans. B

Explanation:

Ans. is ‘b’ i.e., Phenobarbitone 

Lignocaine toxicity

  • Lignocaine toxicity occurs with unintended intravascular administration or with administration of excessive dose
  • Toxicity may be observed at 6 µg/ml, but more commonly occur once levels exceed 10 tg/ml.

Clinical manifestations

1. CNS manifestations

  • These are the most common manifestations of toxicity.
  • CNS lidocaine toxicity is biphasic
  1.  Earlier manifestations→are due to CNS excitation e.g. convulsions
  2.  Subsequent manifestations →are due to CNS depression drowsiness, disorientation, respiratory depression. 
  3.  The cause of biphasic response is
  4.  Local anaesthetic action first blocks inhibitary CNS pathways→resulting in stimulation
  5.  Eventually blocks both inhibitory and excitatory pathways→ overall CNS depression

2. Cardiovascular manifestations

  • These occur at higher serum concentrations
  • There may be cardiac depression, hypotension, coma, respiratory arrest. Note: lignocaine can precipitate malignant hyperthermia

Management of toxicity

  • If lignocaine toxicity is suspected, stop the injection immediately.
  • Ensure adequate oxygenation, whether by face mask or by intubation.
  • Anticonvulsants such as benzodiazepines and barbiturates are the drug of choice for seizure control.
  • Succinykholine is sometimes also used to terminate the neuromuscular effects of seizures.
  • If CVS symptoms occur (cardiac depression and hypotension), IVfluid and vasopressor agents may be required.
  • If metabolic acidosis develops, use of sodium bicarbonate can be considered, although, as in other instances of acute metabolic acidosis, this is controversial


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