Guidelines and the adoption of ‘lipid rescue’ therapy for local anaesthetic toxicity

  title={Guidelines and the adoption of ‘lipid rescue’ therapy for local anaesthetic toxicity},
  author={John Picard and Stephen Ward and Ralph Zumpe and Tim Meek and J Barlow and William A. Harrop-Griffiths},
Gathering evidence from animal experiments, an editorial in this journal and published human case reports culminated in the Association of Anaesthetists of Great Britain and Ireland recommending in August 2007 that lipid emulsion be immediately available to all patients given potentially cardiotoxic doses of local anaesthetic drugs. This development offered an opportunity to track the adoption of an innovation by anaesthetists in the UK and to gauge the effects of guidelines. Two surveys, each… 

Limited knowledge of lipid rescue therapy in local anaesthetic systemic toxicity.

Patients with toxic reactions who could potentially benefit from ILE will not be offered lipid rescue therapy in 26 of 34 hospitals--either because the AA is not aware of this treatment modality, or due to absence of either guidelines or ILE.

Availability of and use of Intralipid (lipid rescue therapy, lipid emulsion) in England and Wales

The majority of hospitals surveyed stocked Intralipid in multiple locations, although not in all areas using high volumes of local anaesthetics, and guidelines were typically in place, although these were often local rather than those from the AAGBI.

Local anaesthetic toxicity: are we prepared for the consequences in the Emergency Department?

The lack of knowledge amongst the more junior staff, as demonstrated by this project, highlights failings in teaching the basics of safe practices in the ED.

Brief Report: Availability of Lipid Emulsion in United States Obstetric Units

The objective of the current study was to estimate the current level of lipid emulsion availability in U.S. academic obstetric units.

Local anesthetic toxicity: Who is ready for lipid resuscitation?

The majority of surveyed German hospitals are prepared to treat toxic reactions to local anesthetics and published guidelines contributed to this preparedness, and it seems desirable that lipid emulsions are generally available in routine clinical practice.

[Lipid emulsion therapy for local anaesthetic toxicity. (LipidRescue)].

  • K. Ott
  • Medicine
    Der Anaesthesist
  • 2010
It is recommended that lipid emulsions are instantly accessible in all facilities where local anaesthetics are administered and the use of lipid emulsion can be initiated as a supplement to standard resuscitation.

Lipid emulsion to treat drug overdose: past, present and future

Treatment with lipid emulsion has swept the nation, and local anaesthetic overdose joined the fearsome company of Anaphylaxis and Malignant Hyperpyrexia as the subject of a laminated, one-page guidance document.

Local anaesthetic systemic toxicity

This review covers LA toxicity, its incidence, clinical features, risk factors, prevention, and management and examines i.v. lipid emulsion (ILE) therapy in more detail.

The use of intravenous lipid emulsion as an antidote in veterinary toxicology.

The use of IV lipid emulsion appears to be a safe therapy for the poisoned animal patient, but is warranted only with certain toxicoses.

Abstracts and Highlight Papers of the 31st Annual European Society of Regional Anaesthesia (ESRA) Congress 2012

  • Medicine
    Regional Anesthesia & Pain Medicine
  • 2012
The likelihood of an adverse event is likely to be reduced by adhering to standards of care during regional anesthesia that include: use of standard monitoring, careful selection of drug and dose, frequent aspiration and small, incremental doses with reasonable intervals between them.



Availability of lipid emulsion in obstetric anaesthesia in the UK: a national questionnaire survey

Around three‐quarters of labour wards in the UK either have lipid emulsion available or plan to obtain it, and around two‐thirds had a recommended dose regimen for its administration.

Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob

Fat is bad for you. It may make our food appetising, but is widely consumed in gross surfeit. In excess, fat harms our patients and impedes any anaesthetic manoeuvre. But fat may also be clinically

Lipid Emulsion Infusion Rescues Dogs From Bupivacaine-Induced Cardiac Toxicity

It was found that infusing a lipid emulsion during resuscitation from bupivacaine-induced cardiac toxicity substantially improved hemodynamics, pmO2, and pHm and increased survival in dogs.

Pretreatment or Resuscitation with a Lipid Infusion Shifts the Dose‐Response to Bupivacaine‐induced Asystole in Rats

Lipid infusion shifts the dose‐response to bupivacaine‐induced asystole in rats and suggests a potential application for lipid infusion in treating cardiotoxicity resulting from bupvacaine.

Successful resuscitation of a patient with ropivacaine‐induced asystole after axillary plexus block using lipid infusion *

This case shows that lipid infusion may have a beneficial role in cases of local anaesthetic toxicity when conventional resuscitation has been unsuccessful, and it is believed the cardiovascular collapse was secondary to ropivacaine absorption following the accidental overdose.

Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest.

The patient was a 58-yr-old, 82-kg, 170-cm male who presented for arthroscopic repair of a torn rotator cuff in the right shoulder who was considered by his cardiologist to be stable on medical therapy and plans were being made to institute cardiopulmonary bypass.

Principles of successful sample surveys.

The arcane subject of modeling binary data using population analysis, a technique that determines the response of the typical individual, as well as interand intraindividual variability, is explored in this issue of the Journal.

Diffusion of innovations

Upon returning to the U.S., author Singhal’s Google search revealed the following: in January 2001, the impeachment trial against President Estrada was halted by senators who supported him and the government fell without a shot being fired.