Confusion About Infusion: Rational Volume Limits for Intravenous Lipid Emulsion During Treatment of Oral Overdoses

Fettiplace, Michael R.; Akpa, Belinda S.; Rubinstein, Israel; Weinberg, Guy

doi:10.1016/j.annemergmed.2015.01.020

Cited by 67 publications

(70 citation statements)

References 40 publications

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“…137,[144][145][146] The safety of prolonged infusions (beyond 1 hour) has not been established. 147 The most common adverse effect of ILE therapy is interference with diagnostic laboratory testing 148 ; rare cases of pancreatitis 148 and pulmonary changes similar to those observed with acute respiratory distress syndrome 149 have also been reported. There appear to be complex pharmacodynamic interactions between ILE and epinephrine given during resuscitation, and in some situations, treatment with ILE alters the effectiveness of epinephrine and vasopressin in animal resuscitation studies.…”

Section: Nomentioning

confidence: 99%

Part 10: Special Circumstances of Resuscitation

Lavonas¹,

Drennan²,

Gabrielli³

et al. 2015

Circulation

239

123

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Section: Nomentioning

confidence: 99%

Part 10: Special Circumstances of Resuscitation

Lavonas¹,

Drennan²,

Gabrielli³

et al. 2015

Circulation

239

123

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“…Thus, it is important to avoid delivering an excessive dose of lipid since dangerous fat overload can occur. 62 Table 5 outlines treatment recommendations.…”

Section: New Treatment Recommendationsmentioning

confidence: 99%

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

Neal

Barrington

Fettiplace

et al. 2018

Regional Anesthesia and Pain Medicine

Self Cite

327

185

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The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.

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“…This advanced understanding of the scavenging effect has implications for clinical treatment of toxicity especially when we consider oral drug overdoses where significant amounts of drug remain outside the circulatory system in the gastrointestinal tract (typically involving drugs other that local anesthetics). 75 …”

Section: Redistributionmentioning

confidence: 99%

The Mechanisms Underlying Lipid Resuscitation Therapy

Fettiplace

Weinberg

2018

Regional Anesthesia and Pain Medicine

Self Cite

108

104

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The experimental use of lipid emulsion for local anesthetic toxicity was originally identified in 1998. It was then translated to clinical practice in 2006 and expanded to drugs other than local anesthetics in 2008. Our understanding of lipid resuscitation therapy has progressed considerably since the previous update from the American Society of Regional Anesthesia and Pain Medicine, and the scientific evidence has coalesced around specific discrete mechanisms. Intravenous lipid emulsion therapy provides a multimodal resuscitation benefit that includes both scavenging (eg, the lipid shuttle) and nonscavenging components. The intravascular lipid compartment scavenges drug from organs susceptible to toxicity and accelerates redistribution to organs where drug (eg, bupivacaine) is stored, detoxified, and later excreted. In addition, lipid exerts nonscavenging effects that include postconditioning (via activation of prosurvival kinases) along with cardiotonic and vasoconstrictive benefits. These effects protect tissue from ischemic damage and increase tissue perfusion during recovery from toxicity. Other mechanisms have diminished in favor based on lack of evidence; these include direct effects on channel currents (eg, calcium) and mass-effect overpowering a block in mitochondrial metabolism. In this narrative review, we discuss these proposed mechanisms and address questions left to answer in the field. Further work is needed, but the field has made considerable strides towards understanding the mechanisms.

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Confusion About Infusion: Rational Volume Limits for Intravenous Lipid Emulsion During Treatment of Oral Overdoses

Cited by 67 publications

References 40 publications

Part 10: Special Circumstances of Resuscitation

Part 10: Special Circumstances of Resuscitation

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

The Mechanisms Underlying Lipid Resuscitation Therapy

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