Elimination and Tolerance of a New Parenteral Lipid Emulsion (SMOF) – A Double-Blind Cross-Over Study in Healthy Male Volunteers

Schlotzer, E.; Kanning, Ulrike

doi:10.1159/000080461

Cited by 54 publications

(40 citation statements)

References 39 publications

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“…In CTRL, values returned to those similar to rest in T 15 and remained constant until the end. In SMOF, after T 5 and until the end these values were higher than those at rest (P<0.001).…”

Section: Right Ventricular Systolic Work Indexmentioning

confidence: 70%

“…In CTRL values only returned to those similar to rest in T 30 and T 10 was lower than T 15 . In SMOF, values did not return to levels similar to T 0 , although they increased from T 20 to T 30 (p<0.001).…”

Section: Cardiac Indexmentioning

confidence: 74%

“…In both groups, pressure values in all time periods were higher than in T 0 . However, in SMOF T 5 and T 15 were also higher than the values immediately prior to those time periods (p<0.001).…”

Section: Pulmonary Capillary Wedge Pressurementioning

confidence: 77%

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Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

et al. 2012

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PURPOSE:To evaluate the hemodynamic changes following SMOFlipid emulsion therapy with after bupivacaine intoxication in swines. METHODS: Large White pigs were anesthetized with thiopental, tracheal intubation was performed and mechanical ventilation was instituted. Hemodynamic variables were recorded with invasive pressure monitoring and pulmonary artery catheterization (Swan-Ganz catheter). After a 30-minute resting period, 5 mg.kg -1 of bupivacaine by intravenous injection was administered and new hemodynamic measures were performed 1 minute later; the animals were than randomly divided into two groups and received 4 ml.kg -1 of saline solution or 4 ml.kg -1 of SMOFlipid emulsion 20%. Hemodynamic changes were then re-evaluated at 5, 10, 15, 20 and 30 minutes. RESULTS: Bupivacaine intoxication caused fall in arterial blood pressure, cardiac index, ventricular systolic work index mainly and no important changes in vascular resistances. SMOFlipid emulsion therapy was able to improve blood pressure mainly by increasing vascular resistance since the cardiac index had no significant improvement in our study. Hemodynamic results of the use of lipid emulsion in bupivacaine intoxication were better than the control group. CONCLUSION: The SMOFlipid emulsion is a option for reversing hypotension in cases of intoxication by bupivacaine. Key words: Anesthesia, Local. Bupivacaine. Lipids. Hemodynamics. Fat Emulsions, Intravenous. Swine. RESUMO OBJETIVO:Avaliar as alterações hemodinâmicas da terapia lipídica com SMOFlipid após intoxicação com bupivacaína em suínos. MÉTODOS: Suínos da raça Large White foram anestesiados com tiopental, realizada intubação traqueal e mantidos em ventilação mecânica. As variáveis hemodinâmicas foram registradas através de pressão invasiva e cateterização da artéria pulmonar (cateter de Swan-Ganz). Após período de 30 minutos de repouso, 5 mg.kg -1 de bupivacaína foram injetados por via endovenosa e novas medidas hemodinâmicas foram realizadas 1 minuto após; os animais foram então aleatoriamente divididos em dois grupos e receberam 4 ml.kg -1 de solução salina ou 4 ml.kg -1 da emulsão tipo SMOFlipid a 20%. As alterações hemodinâmicas foram reavaliadas aos 5, 10, 15, 20 e 30 minutos. RESULTADOS: A intoxicação pela bupivacaína causou queda da pressão arterial, índice cardíaco e do trabalho sistólico dos ventrículos principalmente sem importantes alterações das resistências vasculares. A terapia com a emulsão SMOFlipid foi capaz de melhorar a pressão arterial através, principalmente, do aumento das resistências vasculares uma vez que o índice cardíaco não apresentou melhora expressiva em nosso estudo. Os resultados hemodinâmicos com o uso da emulsão lipídica na intoxicação pela bupivacaína foram melhores que no grupo controle. CONCLUSÃO: A emulsão SMOFlipid é uma opção para reverter a hipotensão em caso de intoxicação pela bupivacaína.

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“…In CTRL, values returned to those similar to rest in T 15 and remained constant until the end. In SMOF, after T 5 and until the end these values were higher than those at rest (P<0.001).…”

Section: Right Ventricular Systolic Work Indexmentioning

confidence: 70%

Section: Cardiac Indexmentioning

confidence: 74%

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Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

et al. 2012

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“…After assay re-calibration against ILE-derived TG, TG were calculated at 670 and 296 mg/dL at 3 and 8 h post-ILE, corresponding to a serum ILE concentration of 0.8 and 0.25 vol%, respectively. Based on ILE concentrations of 0.8 and 0.25 vol% at 3 and 8 h after ILE infusion, the ILE halflife in the patient was approximately 3 h. Because ILE elimination from serum follows first-order kinetics [17], the maximum ILE concentration reached at the end of the ILE infusion can be calculated as 1.6 vol%.…”

Section: Estimating the Serum Ile Concentration Associated With Clinimentioning

confidence: 99%

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

et al. 2015

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Intravenous lipid emulsion (ILE), a component of parenteral nutrition, consists of a fat emulsion of soy bean oil, egg phospholipids, and glycerin. Case reports suggest that ILE may reverse hypotension caused by acute poisoning with lipophilic drugs such as verapamil, but the mechanism remains unclear. The methods used are the following: (1) measurement of ILE concentration in serum samples from a patient with verapamil poisoning treated with ILE, (2) measurement of free verapamil concentrations in human serum mixed in vitro with increasing concentrations of ILE, and (3) measurement of murine ventricular cardiomyocyte L-type Ca 2+ currents, intracellular Ca 2+ , and contractility in response to verapamil and/or ILE. Maximum patient serum ILE concentration after infusion of 1 L ILE over 1 h was approximately 1.6 vol%. In vitro GC/ MS verapamil assays showed that addition of ILE (0.03-5.0 vol%) dose-dependently decreased the free verapamil concentration in human serum. In voltage-clamped myocytes, adding ILE to Tyrode's solution containing 5 μM verapamil recovered L-type Ca 2+ currents (I Ca ). Recovery was concentration dependent, with significant I Ca recovery at ILE concentrations as low as 0.03 vol%. ILE had no effect on I Ca in the absence of verapamil. In field-stimulated intact ventricular myocytes exposed to verapamil, adding ILE (0.5 %) resulted in a rapid and nearly complete recovery of myocyte contractility and intracellular Ca 2+ . Our in vitro studies indicate that ILE acts as a lipid sink that rapidly reverses impaired cardiomyocyte contractility in the continued presence of verapamil.

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“…The use of a 20% n-3 lipid emulsion, which contains a lower amount of phospholipids, would already allow for more efficient triglyceride clearance [38]. Even more, emulsions with the lipid being a mix of MCT, soybean oil, olive oil and fish oil appear to have an increased plasma elimination, as compared to the standard soybean oil emulsion [37,39,40].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Intermittent Fish Oil Infusions in Outpatients with Graft- Versus-Host Disease of the Digestive Tract

et al. 2013

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N-3 polyunsaturated fatty acids from fish oil may have immune-modulating effects in Graft-versus-Host Disease of the digestive tract (GVHD-DT). The objective of this pilot study was to investigate feasibility, safety and effects on fatty acid composition of plasma lipids and white blood cells (WBC), following intermittent fish oil infusion in outpatients with chronic GVHD-DT. Four outpatients received intermittent infusion of a 10% fish oil emulsion (Omegaven) during 4 hours, at day 1 (1.5 mL/kg), 3 (2.25 mL/kg) and 5, 8, 10 and 12 (3 mL/kg). At baseline and consecutive visits, fatty acid composition of plasma triglycerides (TG), plasma phospholipids (PL) and WBC, serum TG concentrations, routine laboratory tests, as well as adverse events were monitored. During the fish oil infusions, serum TG increased, but decreased 2 h after termination of infusion. In 3 patients, the dose of Omegaven ® needed to be reduced. EPA was incorporated into plasma PL, plasma TG and WBC as of 2 days after the first infusion; peak levels of EPA were reached at the final infusion, or 2 days after. In conclusion, intermittent fish oil infusions result in incorporation of EPA in plasma and WBC, but can be complicated by a reversible increase in serum triglycerides.

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Elimination and Tolerance of a New Parenteral Lipid Emulsion (SMOF) – A Double-Blind Cross-Over Study in Healthy Male Volunteers

Cited by 54 publications

References 39 publications

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

Feasibility of Intermittent Fish Oil Infusions in Outpatients with Graft- Versus-Host Disease of the Digestive Tract

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