Lipid Emulsion Infusion Rescues Dogs From Bupivacaine-Induced Cardiac Toxicity

Weinberg, Guy; Ripper, Richard; Feinstein, Douglas L.; Hoffman, William E.

doi:10.1097/00115550-200305000-00005

Cited by 380 publications

(196 citation statements)

References 7 publications

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“…This model suggests that during bupivacaine overdose, early systolic hypertension is not a reliable indicator for recovery. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 (9). These results are consistent with the findings of a previous rabbit study (findings of the group without epinephrine injection) (1).…”

Section: Discussionsupporting

confidence: 84%

“…However, studies testing lipid dosing have never been conducted in animals or humans. An intravenous lipid emulsion has been shown to be effective in the treatment of bupivacaineinduced cardiac arrest (1,(8)(9)(10). Clinical trials in which a lipid emulsion was used in resuscitating subjects with local anesthetic-induced cardiotoxicity have had successful results (3,4,6,7,11).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of resuscitation with Intralipid in a levobupivacaine-induced cardiac arrest model

Karcioglu¹,

Tuzcu²,

Sefil³

et al. 2014

Turk J Med Sci

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Efficacy of resuscitation with Intralipid in a levobupivacaine-induced cardiac arrest model

Karcioglu¹,

Tuzcu²,

Sefil³

et al. 2014

Turk J Med Sci

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“…Tierexperimentelle Untersuchungen haben gezeigt, dass Intralipid® (Sojabohnenöl, Eiphospholipide, Glyzerin, Wasser) ein mögliches Antidot für die systemische LA-Intoxikation darstellt [28,29]. In der Folge wurden Lipidemulsionen auch bei Menschen mit hämodyna-mischem Kollaps infolge LA-Intoxikation erfolgreich eingesetzt [4,12,13,14,17,23,27].…”

Section: Hintergrund Und Fragestellungunclassified

Bupivacaintoxizität und Propofolanästhesie

et al. 2011

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“…durch Lipidinfusionen signifikant attenuiert werden können [38, 255,256]. Inwieweit all diese experimentellen Befunde zur Therapie einer kardiovaskulären Intoxikation auf den menschlichen Organismus übertragen werden können, bleibt mit Spannung abzuwarten [76].…”

Section: Therapieoptionen Bei Systemischer Intoxikationunclassified

Toxikologie der Lokalan�sthetika

Zink

Graf

2003

Der Anaesthesist

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Regardless of their specific physico-chemical properties and chemical structures, all local anaesthetic agents block neuronal voltage-gated sodium channels, and thus suppress conduction in peripheral nerves. Since these ion channels ubiquitously appear in excitable membranes, systemic accumulation of local anaesthetic agents may affect the functional integrity of these structures. Clinically, local anaesthetic-induced systemic toxicity results in central nervous and cardiovascular malfunction. With regard to CNS toxicity, symptoms which are largely drug-independent appear in a characteristic biphasic sequence. Nevertheless, the plasma levels necessary to provoke these symptoms are to a large extent agent-specific. Initially, these toxic mechanisms are due to a selective blockade of cortical inhibitory neurons, which enables the formation of seizure potentials within subcortical structures. With high cerebral drug levels, however, excitatory neurons are also increasingly blocked, resulting in coma, apnoeic episodes and circulatory failure. Direct cardiac effects of local anaesthetics can be divided into (i) stereospecific inhibition of intracardial conduction and (ii) unspecific inhibition of myocardial energy supply and ion channels. The corresponding spectrum of symptoms is not uniform and may range from extreme bradycardia, (malignant) ventricular arrhythmia to refractory cardiac arrest. Local tissue toxicity has to be strictly delimited from systemic toxicity and allergies, respectively, which are mainly caused by aminoester agents. Local anaesthetics may cause neuronal and striated muscle injury at the site of injection. With regard to (central) neurotoxicity, "transient neurologic symptoms" and "cauda equina syndrome" have been increasingly recognised. However, the clinical relevance of local anaesthetic-induced myotoxicity is still controversly discussed. In order to avoid systemic accumulation of local anaesthetic agents, several safety procedures have to be considered during the application of these drugs. The treatment of systemic toxicity is strictly dependent on the expression of symptoms. However, hypoxia and acidotic episodes must be avoided and must be treated aggressively.

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Lipid Emulsion Infusion Rescues Dogs From Bupivacaine-Induced Cardiac Toxicity

Cited by 380 publications

References 7 publications

Efficacy of resuscitation with Intralipid in a levobupivacaine-induced cardiac arrest model

Efficacy of resuscitation with Intralipid in a levobupivacaine-induced cardiac arrest model

Bupivacaintoxizität und Propofolanästhesie

Toxikologie der Lokalan�sthetika

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