Lipid emulsion in local anesthetic toxicity

Harvey, Martyn; Cave, Grant

doi:10.1097/aco.0000000000000498

Cited by 23 publications

(14 citation statements)

References 83 publications

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“… 82 – 85 There is a paucity of large-scale, high-quality data demonstrating the clinical efficacy of lipid emulsion therapy, primarily due to the difficulties in valid data collection and the limited feasibility of prospective studies. 86 , 87 However, animal studies demonstrate strong support for the use of lipid emulsion therapy in reducing mortality when applied in conjunction with resuscitative interventions. 88 …”

Section: Treatmentmentioning

confidence: 99%

Local anesthetic systemic toxicity: current perspectives

El‐Boghdadly¹,

Pawa²,

Chin³

2018

LRA

337

269

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Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes. Increasing use of local anesthetic techniques in various healthcare settings makes contemporary understanding of LAST highly relevant. Recent data have demonstrated that the underlying mechanisms of LAST are multifactorial, with diverse cellular effects in the central nervous system and cardiovascular system. Although neurological presentation is most common, LAST often presents atypically, and one-fifth of the reported cases present with isolated cardiovascular disturbance. There are several risk factors that are associated with the drug used and the administration technique. LAST can be mitigated by targeting the modifiable risk factors, including the use of ultrasound for regional anesthetic techniques and restricting drug dosage. There have been significant developments in our understanding of LAST treatment. Key advances include early administration of lipid emulsion therapy, prompt seizure management, and careful selection of cardiovascular supportive pharmacotherapy. Cognizance of the mechanisms, risk factors, prevention, and therapy of LAST is vital to any practitioner using local anesthetic drugs in their clinical practice.

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Section: Treatmentmentioning

confidence: 99%

Local anesthetic systemic toxicity: current perspectives

El‐Boghdadly¹,

Pawa²,

Chin³

2018

LRA

337

269

View full text Add to dashboard Cite

show abstract

“…However, the dosage was determined in preliminary experiments for the purpose of optimizing recovery. 2) Large doses of lipids may lead to eg, intravascular hemolysis, pulmonary arterial hypertension, hypersensitivity, deep venous thrombosis, and pancreatitis., 57,58 however we were unable to estimate these negative effects in the current study. 3) General anesthesia and mechanical ventilation may have an effect on the pharmacokinetics of study drugs and the responses of the cardiovascular systems in the setting of asphyxia-induced cardiac arrest, although it is indispensable for both practical and ethical considerations.…”

Section: Discussionmentioning

confidence: 61%

<p>Supplement of Lipid Emulsion to Epinephrine Improves Resuscitation Outcomes of Asphyxia-Induced Cardiac Arrest in Aged Rats</p>

Huang

Ren

et al. 2020

CIA

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The goal of the study was to investigate the efficacy of lipid supplement to epinephrine-based therapy in resuscitation of asphyxia-induced cardiac arrest in aged rats. Methods: The study included two parts: in experiment A, rats underwent asphyxial cardiac arrest and cardiopulmonary resuscitation, randomized to receive epinephrine and normal saline (control group, n=22), epinephrine and intralipid 20% (long-chain triglycerides (LCT) group, n=22) or epinephrine and lipovenoes 20% (LCT/medium-chain triglcerides (MCT) group, n=22). Return of spontaneous circulation, recurrence of asystole after resuscitation, hemodynamic metrics, arterial blood gas values, neurological assessment score and indexes of pulmonary transudation were recorded. In experiment B, rats using the same model and resuscitation protocol were randomly divided into 21 groups: Control 0 , Control 20 ,

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“…In addition, it has been used in the treatment of acute lipophilic medication overdose where it redistributes these medications away from tissues and helps in their excretion. Several studies have reported on its use to correct overdose of calcium channel blockers, cardiac medications, and local anesthetics [ 7 – 10 ].…”

Section: Discussionmentioning

confidence: 99%

Intravenous Lipid Emulsion Overdose in Infancy: A Case Report and Overview of Opportunities, Challenges and Prevention

Khasawneh

Hani

2018

Drug Saf - Case Rep

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Medication errors remain among the major problems seen in hospitals. Such errors can relate to the prescription, dispensation, or administration of drugs. Human factors account for most of these mistakes, but other factors such as infusion pump programming defects should always be considered. Worldwide, medication errors have been reported to affect 2–30% of patients, depending on the institution. Intravenous lipid emulsion (ILE) infusion is frequently used as part of total parenteral nutrition in patients of all ages with feeding and gastrointestinal issues. ILE overdose has been previously reported, with variable clinical outcomes. We report a case of accidental ILE (Intralipid) overdose in a 3-month-old male infant who fully recovered after single-volume blood exchange transfusion. We also review reported cases and summarize potential solutions for ILE overdose. Our review indicates that ILE infusion is a high-risk medication, and opportunities for errors remain even in the best hospital set-ups. Attention should be directed towards proper prescription, dosing, dispensation, and administration. Most of the cases indicate the safety breach was at the nursing drug-administration level, with improper pump use or programming, together with other fluid infusion rate switching, being the main possible defects. Strategies targeting the areas of weakness in the drug-delivery pathway are needed. Special attention should be paid towards nursing duties and working hours. In addition, nursing staff should receive frequent education sessions and should be required to pass competency modules regularly. An error-prevention plan should be established and implemented. This plan needs full collaboration between physicians, pharmacists, and nursing staff.

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Lipid emulsion in local anesthetic toxicity

Abstract: Lipid emulsion remains first-line therapy (in conjunction with standard resuscitative measures) in LAST. Increasing conjecture as to the clinical efficacy of ILE in LAST, however, calls for high-quality human data to refine clinical recommendations.

Cited by 23 publications

References 83 publications

Local anesthetic systemic toxicity: current perspectives

Local anesthetic systemic toxicity: current perspectives

<p>Supplement of Lipid Emulsion to Epinephrine Improves Resuscitation Outcomes of Asphyxia-Induced Cardiac Arrest in Aged Rats</p>

Intravenous Lipid Emulsion Overdose in Infancy: A Case Report and Overview of Opportunities, Challenges and Prevention

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