Prophylactic Lidocaine

Robert Lebow, MD
JAMA. 1980;244(24):2729. doi:10.1001/jama.1980.03310240021012.
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To the Editor.—  I certainly agree with Burlington and Freed (1980;243:1036) in their letter, "Massive Overdose and Death From Prophylactic Lidocaine," and others1 that a good double-blind study is necessary in demonstrating whether prophylactic lidocaine hydrochloride leads to reduced mortality after myocardial infarction (MI). However, their implication that prophylactic lidocaine use is inadvisable, in that relatively few patients with an acute MI demonstrate ventricular fibrillation while prophylactic lidocaine exposes all patients to toxic drug reactions, shows poor reasoning. Following this thinking we would not use medication to treat any illness with a mortality of less than 50% because of the possibility of side effects, no matter how remote.Lie et al2 state that "rigid observation of patients and control of infusion rates are required to reduce the likelihood of side effects." The fallacy of the reasoning by the authors is as apparent as is the poor supervision of medication


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