Intravenous Lipid Emulsion Alters the Hemodynamic Response to Epinephrine in a Rat Model

Abstract

Intravenous lipid emulsion (ILE) is an adjunctive antidote used in selected critically ill poisoned patients. These patients may also require administration of advanced cardiac life support (ACLS) drugs. Limited data is available to describe interactions of ILE with standard ACLS drugs, specifically epinephrine. Twenty rats with intra-arterial and intravenous access were sedated with isoflurane and split into ILE or normal saline (NS) pretreatment groups. All received epinephrine 15 μm/kg intravenously (IV). Continuous mean arterial pressure (MAP) and heart rate (HR) were monitored until both indices returned to baseline. Standardized t tests were used to compare peak MAP, time to peak MAP, maximum change in HR, time to maximum change in HR, and time to return to baseline MAP/HR. There was a significant difference (p=0.023) in time to peak MAP in the ILE group (54 s, 95 % CI 44-64) versus the NS group (40 s, 95 % CI 32-48) and a significant difference (p=0.004) in time to return to baseline MAP in ILE group (171 s, 95 % CI 148-194) versus NS group (130 s, 95 % CI 113-147). There were no significant differences in the peak change in MAP, peak change in HR, time to minimum HR, or time to return to baseline HR between groups. ILE-pretreated rats had a significant difference in MAP response to epinephrine; ILE delayed the peak effect and prolonged the duration of effect of epinephrine on MAP, but did not alter the peak increase in MAP or the HR response.

Part 10: Special Circumstances of Resuscitation

“…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.…”

Epinephrine Administration in Lipid-Based Resuscitation in a Rat Model of Bupivacaine-Induced Cardiac Arrest

“…4,5 The primary mechanism of action of epinephrine is on the α-receptor response, 6-8 thereby leading to increased coronary vascular pressure. Lipid administration delays the peak effect of epinephrine 9 and prolongs its duration of action on mean arterial pressure (MAP) but does not alter the peak increase in MAP or the heart rate (HR). Our recent work 10 demonstrated that a combination of lipid emulsion with epinephrine was superior to the administration of lipid emulsion alone with regard to successful resuscitation.…”

The Effect of L-Carnitine and Intralipid Emulsion in Acute Verapamil Cardiotoxicity in Albino Rats

“…Myocardial contraction is primarily driven by beta-oxidation of free fatty acids, a process which accounts for 50-70 % of myocardial ATP production. ILE, which is composed primarily of long chain fatty acids, provides a potential source of energy for the myocardium (Carreiro et al, 2013). In addition, intralipid infusion increases b-ketoacids and nitric oxide which stimulate insulin secretion and subsequently reverse the hypoinsulinemia induced by verapamil blockade of pancreatic islet-cell L-type calcium channels and so facilitate increased carbohydrate entry into myocytes (Tebbutt et al, 2006).…”