Early Lipid Emulsion Treatment of Central Nervous System Symptoms Induced by Ropivacaine Toxicity: A Case Report

Lee, Soo Hee; Park, Miyeong; Ok, Seong-Ho; Hwang, Yeran; Park, Kyeong-Eon; Bae, Sung Il; Yoon, Sangcheol; Sohn, Ju-Tae

doi:10.1097/mjt.0000000000001198

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…[ 1 ] Early lipid emulsion administration in patients with bupivacaine- or ropivacaine-induced central nervous system symptoms prior to the onset of cardiac symptoms treated perioral numbness, restlessness, agitation, dizziness, and dysarthria. [ 69 , 70 ] In addition, a randomized controlled study suggested that lipid emulsion shortened the recovery time from isoflurane anesthesia, leading to improved recovery quality. [ 71 , 72 ] An animal study also corroborated that lipid emulsion shortened the time from isoflurane anesthesia to recovery, and decreased the proportion of the delta-band in the electroencephalogram during anesthesia, which appears to be mediated by lipid emulsion-induced reduction of isoflurane concentrations.…”

Section: Discussionmentioning

confidence: 99%

Effect of lipid emulsion on neuropsychiatric drug-induced toxicity: A narrative review

Hwang,

Sohn

2024

Medicine

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Lipid emulsion has been shown to effectively relieve refractory cardiovascular collapse resulting from toxic levels of nonlocal anesthetics. The goal of this study was to examine the effect of lipid emulsions on neuropsychiatric drug-induced toxicity using relevant case reports of human patients, with a particular focus on the Glasgow Coma Scale (GCS) score and corrected QT interval, to analyze drugs that frequently require lipid emulsion treatment. The following keywords were used to retrieve relevant case reports from PubMed: “antidepressant or antipsychotic drug or amitriptyline or bupropion or citalopram or desipramine or dosulepin or dothiepin or doxepin or escitalopram or fluoxetine or haloperidol or olanzapine or phenothiazine or quetiapine or risperidone or trazodone” and “lipid emulsion or Intralipid.” Lipid emulsion treatment reversed the corrected QT interval prolongation and decreases in Glasgow Coma Scale scores caused by toxic doses of neuropsychiatric drugs, especially lipid-soluble drugs such as amitriptyline, trazodone, quetiapine, lamotrigine, and citalopram. The log P (octanol/water partition coefficient) of the group which required more than 3 lipid emulsion treatments was higher than that that of the group which required less than 3 lipid emulsion treatments. The main rationale to administer lipid emulsion as an adjuvant was as follows: hemodynamic depression intractable to supportive treatment (88.3%) > lipophilic drugs (8.3%) > suspected overdose or no spontaneous breathing (1.6%). Adjuvant lipid emulsion treatment contributed to the recovery of 98.30% of patients with neuropsychiatric drug-induced toxicity. However, further analyses using many case reports are needed to clarify the effects of lipid emulsion resuscitation.

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Section: Discussionmentioning

confidence: 99%

Effect of lipid emulsion on neuropsychiatric drug-induced toxicity: A narrative review

Hwang,

Sohn

2024

Medicine

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“… 7 The early administration of LE alone for systemic toxicity caused by bupivacaine and ropivacaine was reported to treat prodromal and central nervous system symptoms, such as perioral numbness, agitation, restlessness, dysarthria, and dizziness. 8 , 9 In addition, a combined treatment with LE and benzodiazepine in a patient with only neurologic symptoms due to ropivacaine toxicity was reported to ameliorate the symptoms. 10 , 11 Furthermore, a prospective clinical study reported that LE shortened recovery time for isoflurane anesthesia and increased GCS in drug toxicity caused by non-LA.…”

Section: Discussionmentioning

confidence: 99%

Lipid emulsion–induced recovery from unconsciousness caused by lidocaine toxicity: A case report

Park

Lee

et al. 2023

SAGE Open Medical Case Reports

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Lipid emulsion is used to treat systemic toxicity caused by local anesthetics. In addition, lipid emulsion was reported to be effective in ameliorating cardiovascular depression evoked by non-local anesthetic drug toxicity with high lipid solubility. A 47-year-old woman underwent local anesthetic infiltration with 40 mL of 2% lidocaine (20 and 20 mL) to remove a mass in the upper back. After operation, she experienced convulsions and loss of consciousness due to lidocaine toxicity. Midazolam followed by lipid emulsion was administered to treat central nervous system symptoms including unconsciousness and decreased Glasgow Coma Scale. The patient recovered from unconsciousness and presented improved Glasgow Coma Scale after lipid emulsion administration, and then fully recovered from local anesthetic systemic toxicity. This case suggests that early lipid emulsion treatment, before further progression of local anesthetic systemic toxicity, provides an enhanced recovery from unconsciousness and decreased Glasgow Coma Scale due to lidocaine toxicity.

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“…Between December 2017 and May 2020, there were a further 36 cases of LAST reported in 34 peer‐reviewed published articles [6–39]. These data indicated 30% of patients were older than 65 y, and 6% were younger than 5 y. Sixty‐one percent of cases occurred in the hospital; 17% in outpatient surgery centres; and 14% in outpatient clinics (e.g.…”

Section: Clinical Presentationmentioning

confidence: 99%

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

et al. 2021

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Summary Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non‐anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at‐risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.

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Early Lipid Emulsion Treatment of Central Nervous System Symptoms Induced by Ropivacaine Toxicity: A Case Report

Cited by 9 publications

References 8 publications

Effect of lipid emulsion on neuropsychiatric drug-induced toxicity: A narrative review

Effect of lipid emulsion on neuropsychiatric drug-induced toxicity: A narrative review

Lipid emulsion–induced recovery from unconsciousness caused by lidocaine toxicity: A case report

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

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