Lipid Emulsion for Local Anesthetic Systemic Toxicity

Abstract

The accidental overdose of local anesthetics may prove fatal. The commonly used amide local anesthetics have varying adverse effects on the myocardium, and beyond a certain dose all are capable of causing death. Local anesthetics are the most frequently used drugs amongst anesthetists and although uncommon, local anaesthetic systemic toxicity accounts for a high proportion of mortality, with local anaesthetic-induced cardiac arrest particularly resistant to standard resuscitation methods. Over the last decade, there has been convincing evidence of intravenous lipid emulsions as a rescue in local anesthetic-cardiotoxicity, and anesthetic organisations, over the globe have developed guidelines on the use of this drug. Despite this, awareness amongst practitioners appears to be lacking. All who use local anesthetics in their practice should have an appreciation of patients at high risk of toxicity, early symptoms and signs of toxicity, preventative measures when using local anesthetics, and the initial management of systemic toxicity with intravenous lipid emulsion. In this paper we intend to discuss the pharmacology and pathophysiology of local anesthetics and toxicity, and the rationale for lipid emulsion therapy.

Conduction Disturbances and Ventricular Arrhythmias Associated with High- Dose Loperamide

“…It has been shown to reduce the aqueous plasma concentration of bupivacaine to a much greater extent than expected by hemodilution alone [17,18]. Additional proposed mechanisms of action include the increase of calcium channel current leading to enhanced cardiac function, as well as acting as a direct myocardial energy source [18][19][20]. Intralipid has been reported effective in cases of local anesthetic, psychotropic drug, beta-blocker, and calcium channel blocker overdoses [18][19][20].…”

“…Additional proposed mechanisms of action include the increase of calcium channel current leading to enhanced cardiac function, as well as acting as a direct myocardial energy source [18][19][20]. Intralipid has been reported effective in cases of local anesthetic, psychotropic drug, beta-blocker, and calcium channel blocker overdoses [18][19][20]. As our patient had very brief episodes of TdP with improving intervals after sodium bicarbonate and magnesium administration, this therapy was not pursued.…”

Intoxication grave aux anesthésiques locaux lors d’une circoncision

“…Le risque permanent de toxicité systémique des anesthési-ques locaux impose la connaissance des mesures de réani-mation de base notamment en cas de crise convulsive ou d'arrêt cardiorespiratoire, la surveillance des paramètres cardiorespiratoires des patients sous scope au cours et au décours de la procédure, la mise en place d'une voie veineuse périphérique avant l'administration d'anesthésiques locaux, et la disponibilité du matériel de réanimation et de médica-ments d'urgence spécifiques (émulsion lipidique intraveineuse) en cas de signes d'intoxication systémique aux anesthésiques locaux [2,10]. Les émulsions lipidiques restent à ce jour le seul traitement dont l'efficacité clinique est démontrée en cas d'accident toxique aux anesthésiques locaux [11][12][13]. Dans notre observation, le diagnostic d'intoxication systé-mique aux anesthésiques locaux n'avait pas été évoqué avant l'arrivée à l'hôpital.…”

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

“…Plasma levels at this rate of infusion are generally less than 3-5 μg/ml, but awake patients may complain of light-headedness, perioral numbness, dizziness and or sedation. Toxic plasma lidocaine levels are considered to be in the >6 μg/ml range [130]. Early signs of local anaesthetic systemic toxicity (LAST) will present as perioral numbness, metallic taste, tinnitus, visual and auditory disturbances, paresthesias, nausea, dizziness and drowsiness [7,[131][132][133].…”