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… 

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TLDR
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References

SHOWING 1-10 OF 13 REFERENCES
Lipid Emulsion Infusion Rescues Dogs From Bupivacaine-Induced Cardiac Toxicity
TLDR
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.
TLDR
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
TLDR
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
TLDR
In conclusion, severe bupivacaine-induced cardio vascular collapse in dogs was effectively reversed with the insulin treatment.
Reply to Drs. Goor, Groban, and Butterworth—Lipid Rescue: Caveats and Recommendations for the “Silver Bullet”
  • G. Weinberg
  • Medicine
    Regional Anesthesia & Pain Medicine
  • 2003
TLDR
Given the high-lipid solubility of the drugs reported so far, it might after all to be sequestration of the drug in the lipid emulsion and a change in the pharmacokinetics, but this will till have to be investigated further.
Dantrolene in human malignant hyperthermia.
TLDR
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
TLDR
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
TLDR
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
TLDR
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
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