Hemodynamic changes with high infusion rates of lipid emulsion. Experimental study in swine

Abstract

PURPOSE:To evaluate hemodynamic changes caused by sole intravenous infusion of lipid emulsion with doses recommended for treatment of drug-related toxicity. METHODS:Large White pigs underwent general anesthesia, tracheal intubation was performed, and mechanical ventilation was instituted. Hemodynamic variables were recorded using invasive blood pressure and pulmonary artery catheterization. Baseline hemodynamic measurements were obtained after a 30-minute stabilization period. An intravenous bolus injection of 20% lipid emulsion at 1.5 ml/kg was administered. Additional hemodynamic measurements were made after 1 minute, followed by a continuous intravenous lipid infusion of 0.25 ml/kg/min. Further measurements were carried out at 10, 20 and 30 minutes, when the infusion was doubled to 0.5 ml/kg/min. Assessment of hemodynamic changes were then made at 40, 50 and 60 minutes. RESULTS:Lipid infusion did not influence cardiac output or heart rate, but caused an increase in arterial blood pressure, mainly pulmonary blood pressure due to increased vascular resistance. Ventricular systolic stroke work consequently increased with greater repercussions on the right ventricle. CONCLUSION:In doses used for drug-related toxicity, lipid emulsion cause significant hemodynamic changes with hypertension, particularly in the pulmonary circulation and increase in vascular resistance, which is a factor to consider prior to use of these solutions.

Sodium bicarbonate reverts electrophysiologic cardiotoxicity of ropivacaine faster than lipid emulsions in a porcine model

“…They also suggested that such hypersensitivity reactions typically increase the pulmonary arterial pressure (PAP) and decrease the systemic pressure 36 . ILE treatment for pigs has been associated with an increase in PAP without affecting oxygenation parameters 20,36,37 . Studies of critically ill patients have also shown that common doses of ILEs used for parenteral nutrition increase PAP 38 .…”

“… 36 ILE treatment for pigs has been associated with an increase in PAP without affecting oxygenation parameters. 20 , 36 , 37 Studies of critically ill patients have also shown that common doses of ILEs used for parenteral nutrition increase PAP. 38 However, the magnitude of the effect of ILE treatment on PAP at doses used for LAST (more than 50 times higher than those used for parenteral nutrition) on humans is unknown.…”

Cholesterol Efflux: Does It Contribute to Aortic Stiffening?

“…Indeed, the overexpression of either Apo A1 or ABCA1 can result in an increase in cholesterol efflux and a decrease in fatty acid synthesis [ 60 ]. Moreover, high-rate infusions of intralipid increase systemic vascular resistance as well as reduce vascular compliance in both humans and animals [ 61 , 62 , 63 ]. These data raise the possibility that cholesterol efflux may contribute to aortic stiffness via its interaction with fatty acid metabolism.…”