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January 7, 1983

`Bolus' Injections of Lidocaine

Author Affiliations

University of Illinois College of Medicine Chicago

JAMA. 1983;249(1):20. doi:10.1001/jama.1983.03330250016012

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To the Editor.—  The recent letter of Dr Miller (1982;248:831) justifiably sounded the alarm about the misleading and dangerous slang in medicine, ie, the intravenous (IV) "bolus" injection. Although the initial saturating dose of many drugs should be given within a short time period to attain efficacy (eg, contrast materials or antiarrhythmics), one is limited to a certain safe speed, since all drugs given IV have to pass through the heart and, therefore, may cause serious side effects—arrhythmias, cardiac depression, and/or death. The letter of Antonelli and Bloch (1982; 248:827) verified sinus standstill after lidocaine hydrochloride administration that was given in a bolus injection of 50 mg/51 kg, or 1 mg/kg, as recommended. However, one dimension, the time of injection was not reported. During the past two decades, I collected a dozen cases of sinus standstill after bolus injections of lidocaine. Several patients required external and internal cardiac massage, and