Lipid resuscitation for local anesthetic toxicity: Is it really lifesaving?

Current Opinion in Anaesthesiology

Volumn 22, Issue 5, 2009, Pages 667-671

  Leskiw, Ulana ^a   Weinberg, Guy L ^a,b  

^a UNIVERSITY OF ILLINOIS   (United States)

^b JESSE BROWN VA MEDICAL CENTER   (United States)

Author keywords

Lipid emulsion; Local anesthetics; Resuscitation; Toxicity

Indexed keywords

ADRENALIN; AMFEBUTAMONE; AMYLASE; CLOMIPRAMINE; LAMOTRIGINE; LIPID; LIPID EMULSION; PROPRANOLOL DERIVATIVE; VASOPRESSIN; VERAPAMIL;

AMYLASE LEVEL; ANESTHESIA; CARDIOTOXICITY; DRUG EFFICACY; DRUG MECHANISM; DRUG OVERDOSE; DRUG SAFETY; HEART ARREST; HUMAN; HYPOXEMIA; LABORATORY TEST; LOCAL ANESTHESIA; LUNG INJURY; NONHUMAN; OUTCOME ASSESSMENT; PRACTICE GUIDELINE; PRIORITY JOURNAL; RESUSCITATION; REVIEW; TOXICITY;

ANESTHETICS, LOCAL; ANIMALS; BLOOD GAS ANALYSIS; FAT EMULSIONS, INTRAVENOUS; GUIDELINES AS TOPIC; HEART ARREST; HUMANS;

EID: 70349139690     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/ACO.0b013e32832eb93f     Document Type: Review

References (28)

1. Albright G. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51:285-287.
2. Weinberg G, VadeBoncouer T, Ramaraju G, et al. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology 1998; 88:1071-1075.
3. Weinberg G, Ripper R, Feinstein D, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med 2003; 28:198-202.
4. Rosenblatt MA, Abel M, Fischer GW, et al. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006; 105:217-218.
5. Litz RJ, Popp M, Stehr SN, Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia 2006; 61:800-801.
6. Foxall G, McMahon R, Lamb J, et al. Levobupivacaine-induced seizures and cardiovascular collapse treated with Intralipid. Anaesthesia 2007; 62:516-518.
7. McCutchen T, Gerancher JC. Early Intralipid therapy may have prevented bupivacaine-associated cardiac arrest. Reg Anesth Pain Med 2008; 33:178-180. This study describes use of lipid emulsion to successfully treat CNS signs and ventricular tachycardia with a pulse in a patient after nerve block.
8. Ludot H, Tharin JY, Belouadah M, et al. Successful resuscitation after ropivacaine and lidocaine-induced ventricular arrhythmia following posterior lumbar plexus block in a child. Anesth Analg 2008; 106:1572-1574. This study describes the successful use of Medialipid to treat a 13-year-old girl who developed ventricular tachycardia after lumbar plexus block with ropivacaine.
9. Litz RJ, Roessel T, Heller AR, Stehr S. Reversal of central nervous system and cardiac toxicity after local anesthetic intoxication by lipid emulsion injection. Anesth Analg 2008; 106:1575-1577. This study describes the successful use of lipid emulsion to reverse CNS signs and treat ventricular ectopy in a patient who received brachial plexus block.
10. Warren J, Thoma RB, Georgescu A, Saurin S. Intravenous lipid infusion in the successful resuscitation of local anesthetic-induced cardiovascular collapse after supraclavicular brachial plexus block. Anesth Analg 2008; 106:1578-1580. This study describes the successful use of Liposyn III to treat cardiac arrest after brachial plexus block.
11. Tebbutt S, Harvey M, Nicholson T, Cave G. Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med 2006; 13:134-139.
12. Bania TC. Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium and normal saline. Acad Emerg Med 2007; 14:105-111.
13. Harvey M, Cave G. Intralipid outperforms sodium bicarbonate in a rabbit model of clomipramine toxicity. Ann Emerg Med 2007; 49:178-185.
14. Harvey MG, Cave GR. Intralipid infusion ameliorates propranolol-induced hypotension in rabbits. J Med Toxicol 2008; 4:71-76.
15. Sirianni AJ, Osterhoudt KC, Callelo DP, et al. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med 2008; 51:412-415. This study describes the first clinical use of lipid emulsion to treat a patient with toxicity due to lipophilic medications other than local anesthetics.
16. Finn SDH, Uncles DR, Willers J, Sable N. Early treatment of quetiapine and sertraline overdose with Intralipid. Anaesthesia 2009; 64:191-194. This study describes the use of lipid emulsion to reverse coma in a patient with drug overdose.
17. Young AC, Velez LI, Kleinschmidt KC. Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation 2009; 80:591-593. This study describes the use of lipid emulsion to treat hypotension due to overdose of sustained-release verapamil.
18. Weinberg G, Di Gregorio G, Hiller G, et al. Lipid emulsion reversal of haloperidol-induced cardiac arrest. Ann Intern Med 2009; 150:737-738. This study describes the successful use of lipid emulsion to treat pulseless multiform ventricular tachycardia resulting from administration of haldol.
19. Perez E, Bania TC, Medlej K, Chu J. Determining the optimal dose of intravenous fat emulsion for the treatment of severe verapamil toxicity in a rodent model. Acad Emerg Med 2008; 15:1284-1289. In this animal study of treatment of verapamil toxicity, the optimal dose of lipid was approximately 18 ml/kg.
20. Spence A. Lipid reversal of central nervous system symptoms of bupivacaine toxicity (letter). Anesthesiology 2007; 107:516-517.
21. Marwick PC, Levin AI, Coetzee AR. Recurrence of bupivacaine toxicity after lipid rescue from bupivacaine-induced cardiac arrest. Anesth Analg 2009; 108:1344-1346. This study describes a patient who developed recurrence of ventricular ectopy 40 min after successful resuscitation from cardiac arrest with lipid. Amylase was elevated postoperatively, but no signs of pancreatitis were noted.
22. Weinberg G, DiGregorio G, Ripper R, et al. Resuscitation with lipid versus epinephrine in a rat model of bupivacaine overdose. Anesthesiology 2008; 108:907-913. This study of bupivacaine-induced cardiac arrest in a rat model found that lipid was superior to epinephrine with respect to resuscitation rates and metabolic parameters.
23. Di Gregorio G, Schwartz D, Ripper R, et al. Lipid emulsion is superior to vasopressin in a rodent model of resuscitation from toxin-induced cardiac arrest. Crit Care Med 2009; 37:993-999. This study in a rat model found that lipid was superior to vasopressin and vasopressin/epinephrine for resuscitation of bupivacaine-induced cardiac arrest.
24. Hiller D, Di Gregorio G, Ripper R, et al. Epinephrine impairs lipid resuscitation from bupivacaine overdose: a threshold effect. Anesthesiology (in press). In this study of bupivacaine-induced cardiac arrest in a rat model, epinephrine more than 10 mg/kg hindered resuscitation.
25. Mayr VD, Mitterschiftthaler L, Neurater A, et al. Comparison of the combination of epinephrine and vasopressin with lipid emulsion in a porcine model of asphyxial cardiac arrest after intravenous injection of bupivacaine. Anesth Analg 2008; 106:1566-1571. In this study of bupivacaine toxicity in a porcine asphyxial model, vasopressin/ epinephrine resulted in a better short-term survival than lipid emulsion.
26. Harvey M, Cave G, Kazemi A. Intralipid infusion diminishes return of spontaneous circulation after hypoxic cardiac arrest in rabbits. Anesth Analg 2009; 108:1163-1168. In this study, in a rabbit asphyxial model of cardiac arrest without lipophilic toxins, ACLS alone resulted in better return of spontaneous circulation than ACLS/lipid emulsion.
27. Gueugniaud PY, David JS, Chanzy E, et al. Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 2008; 359:21-30. In this large study of epinephrine/vasopressin versus epinephrine alone for out-ofhospital cardiac arrest, there were no significant differences between groups in survival to hospital admission (approximately 21%) or survival to hospital discharge (approximately 2%).
28. Mazoit JX, Le Guen R, Beloeil H, Benhamou D. Binding of long-lasting local anesthetics to lipid emulsions. Anesthesiology 2008; 106:1333-1336. This in-vitro study demonstrated high solubility of local anesthetics in lipid emulsion and high binding capacity of lipid emulsions.