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

@article{Picard2006LipidET,
  title={Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob},
  author={John Picard and Tim Meek},
  journal={Anaesthesia},
  year={2006},
  volume={61}
}
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 useful. An intravenous bolus of lipid may save lives in one otherwise lethal situation, namely refractory cardiovascular collapse caused by an overwhelming overdose of local anaesthetic. So, how can lipid help? One lipid emulsion – Intralipid ; (Fresenius Kabi, Runcorn, UK) – is a time-honoured… 

Lipid emulsion for local anaesthetic toxicity

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Lipid emulsion for local anaesthetic toxicity

The experience with introducing Intralipid into operating theatres shows that a system such as this can be easily implemented and would encourage other hospitals to consider doing the same.

[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.

Binding of Local Anaesthetics to the Lipid Emulsion Clinoleic™ 20%

There was no significant difference between Intralipid and Clinoleic in terms of their buffering behaviour, suggesting equivalent binding efficacy, and bupivacaine was more effectively bound by the lipid agents.

In defence of lipid resuscitation

This letter underscores the need for further studies to define an optimal and safe method for lipid infusion in local anaesthetic toxicity and joins Picard and Meek in their support of Wildsmith's suggestion to remain mindful of the need to prevent anaesthetic complications.

Lipid emulsion to treat overdose of local anaesthetic

One observation is an admission of personal recent failure to intubate the trachea of a woman during Caesarean section when the spinal proved to be inadequate.

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.

Intravenous lipid emulsion for local anesthetic toxicity: A review of the literature

IVLE has shown to be an interesting prospect for local anesthetic toxicity, and human case reports have shown successful resuscitation with use of IVLE, using varying dosing regimens.

Local anaesthetic toxicity: prevention or cure?

The report from Litz and colleagues is taken by many as the report, awaited with interest by Weinberg, of the successful use of lipid infusion in the treatment of severe local anaesthetic toxicity, but the paper fails to discuss two important aspects.
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References

SHOWING 1-10 OF 13 REFERENCES

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.

Hemodynamic effects of intravenous 20% soy oil emulsion following coronary bypass surgery.

It is concluded that 20% soy oil emulsion can be administered safely to the recently postoperative cardiac surgical patient recovering from coronary bypass grafting, but the rate should not exceed the maximum clearance rate of 1 ml/min (2.67 mg/kg/min).

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.

The Effect of Insulin on the Resuscitation of Bupivacaine-Induced Severe Cardiovascular Toxicity in Dogs

In conclusion, severe bupivacaine-induced cardio vascular collapse in dogs was effectively reversed with the insulin treatment.

Dantrolene in human malignant hyperthermia.

The study supports animal data suggesting that dantrolene is specific in reversing MH and results in a statistically significantly lower mortality rate than would be expected in MH patients.

Dantrolene in Human Malignant Hyperthermia A Multicenter Study

The study supports animal data suggesting that dantrolene is specific in reversing malignant hyperthermia and results in a statistically significant lower mortality rate than would be expected in MH patients.

Treatment of Bupivacaine-induced Cardiac Arrhythmias in Hypoxic and Hypercarbic Pigs with Amiodarone or Bretylium

Nine animals out of ten treated with amiodarone survived (stable sinus rhythm, arterial blood pressure at near control level, normocarbia), whereas six animals in the bretylium group and four in the control group died; the difference in survival was not, however, statistically significant.

Bupivacaine Inhibits Acylcarnitine Exchange in Cardiac Mitochondria

Bupivacaine inhibits mitochondrial state III respiration when acylcarnitines are the available substrate, which hypothesize supports the clinical relevance of inhibition of carnitine–acylcarnitine translocase by local anesthetics with a cardiotoxic profile.

Weinberg's dose regimen for use in humans