Past, Present, and Future of Lipid Resuscitation Therapy

Fettiplace, Michael R.; Weinberg, Guy

doi:10.1177/0148607115595979

Cited by 42 publications

(50 citation statements)

References 195 publications

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“…Lokal anestezik ajanlar kalp hücrelerindeki mitokondriyal metabolizmayı ve böylece inotropik etkiyi değiştirme ile kardiyak toksisite oluşturur. Böylece kardiyak indeks, ortalama arter basıncı, kalp hızı ve sol ventrikül atım işi azalır ve sonuçta kardiyak arrest gelişerek hastalar kaybedilmektedir (3). Lokal anesteziğin toksisite yapan dozu birçok faktörden etkilenir, ilacın veriliş yolu ve hızı çok önemlidir.…”

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Knowledge of the Research Assistants Regarding Local Anaesthetics and Toxicity

Karasu¹,

Yılmaz²,

Özgünay³

et al. 2016

Turk J Anaesth Reanim

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Amaç: Lokal anestezikler uygun yoğunlukta verildiklerinde, uygulama yerinden başlayarak sinir iletimini geçici olarak bloke ederler. Toksisitede kardiyovasküler sistem depresyonu, solunum arresti, koma, konvülsiyonlar, bilinç kaybı, kas seğirmesi, görme bozukluğu, baş dönmesi, sersemlik ve dilde uyuşma görülebilir. Toksisite tedavisinde ise hava yolu kontrolü sağlanması, konvülsiyon gibi oluşabilecek semptomların tedavisi ve %20 lipid solüsyonu kullanılmaktadır. Bu çalışmanın amacı yaygın olarak kullanılan lokal anestezikler ve toksisitesi hakkında araştırma görevlilerinin bilgilerini incelemek ve lokal anestezikler hakkında farkındalığı arttırmaktır.Yöntemler: Hastanemizde farklı branşlarda çalışmakta olan 115 araştırma görevlisine 20 sorudan oluşan anket formu verildi. Bulgular:Yüz iki (%88,6) katılımcı anketi tamamladı. Katılım-cıların yaş ortalaması 28,73 idi. En çok %15,8 oranında Acil Tıp Kliniği ankete katıldı. Katılımcıların %40,6'sı 2-5 yıldır araştırma görevlisi idi. Katılımcıların %44,4'ü lokal anestezikleri hergün kullanmakta iken %70,3'ü bu konu ile ilgili hiçbir eğitim almamıştı. Anesteziyoloji ve Reanimasyon Kliniği araştırma görevlileri diğer kliniklerden anlamlı olarak yüksek oranda (%76,9) lokal anestezikler ile ilgili eğitim almıştı. Lokal anestezik toksisitesinde erken dönem bulgular ile ilgili soruya anafilaksi (%12,7), aritmi (%12,7) ve geç klinik bulgular ile ilgili soruya hepatotoksisite (%10,8) cevabı en çok verildi. Katılımcıların %87,9'u daha önce lokal anestezik toksisitesi hiç görmemişti. Lokal anestezik toksisitesinde %20 lipid kullanımını katılımcıların %67,4'ü duymamış-tı. %20 lipid kullanımını duyan katılımcılar (%52,2) ise uzmanlarından duymuşlardı. Hastanemizde %20 lipid solüsyonu olmasına rağmen %8,4 katılımcı bunu biliyordu. Sonuç:Özellikle lokal anestezik toksisitesi hakkında ek eğitim programı ile bu eksikliklerin giderilmesi gerektiğini düşünüyoruz. Anahtar kelimeler: Lokal anestezik, toksisite, anketObjective: Cardiovascular system depression, respiratory arrest, coma, convulsions, loss of consciousness, muscle twitching, blurred vision, vertigo, dizziness and numbness of the tongue can be seen in local anaesthetic toxicity. Treatment includes 20% lipid solutions, airway control, symptomatic treatment for arrhythmia and convulsions. The aim of this study is to present the knowledge of research assistants, who used local anaesthetics in daily practice, regarding these medications and toxicity treatment and to raise awareness. Methods:The questionnaire comprising 20 questions was administered to 115 research assistants who worked at different specialities in our hospital. Results:One hundred and two (88.6%) research assistants answered the questionnaire. Participants' mean age was 28.93 years. Most of them were from the Emergency Department (15.7%). A total of 40.6% of participants worked for 2-5 years at their departments. Local anaesthetics were used in daily practice for 44.4% of them, but 70.3% of them had not been educated about local anaesthetics. Research assistants ...

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Knowledge of the Research Assistants Regarding Local Anaesthetics and Toxicity

Karasu¹,

Yılmaz²,

Özgünay³

et al. 2016

Turk J Anaesth Reanim

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“…To decrease the amount of active drug in the target tissues, especially in the heart and brain, we quickly administered a dose of 6 mL/kg of Intralipid, which had an immediate positive effect on the patient's blood pressure. Intralipid may have acted as a vehicle-and not through a 'lipid sink phenomenon', as has described previously [11][12][13]. ILE may have carried the stimulant drug from the heart and brain to less well-perfused organs (scavenging effect), and then once the concentration of caffeine was sufficiently low, ILE may have acted as a tonic to the depressed heart.…”

Section: Resultsmentioning

confidence: 89%

Intralipid in acute caffeine intoxication: a case report

et al. 2016

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Caffeine is arguably the most widely used stimulant drug in the world. Here we describe a suicide attempt involving caffeine overdose whereby the patient's severe intoxication was successfully treated with the prompt infusion of Intralipid. A 19-year-old man was found in an agitated state at home by the volunteer emergency team about 1 h after the intentional ingestion of 40 g of caffeine (tablets). His consciousness decreased rapidly, followed quickly by seizures, and electrocardiographic monitoring showed ventricular fibrillation. Advanced life support maneuvers were started immediately, with the patient defibrillated 10 times and administered 5 mg epinephrine in total and 300 + 150 mg of amiodarone (as well as lidocaine and magnesium sulfate). The cardiac rhythm eventually evolved to asystole, necessitating the intravenous injection of epinephrine to achieve the return of spontaneous circulation. However, critical hemodynamic instability persisted, with the patient's cardiac rhythm alternating between refractory irregular narrow complex tachycardia and wide complex tachycardia associated with hypotension. In an attempt to restore stability we administered three successive doses of Intralipid (120 + 250 + 100 mg), which successfully prevented a severe cardiovascular collapse due to a supra-lethal plasma caffeine level (>120 mg/L after lipid emulsion). The patient survived without any neurologic complications and was transferred to a psychiatric ward a few days later. The case emphasizes the efficacy of intravenous lipid emulsion in the resuscitation of patients from non-local anesthetic systemic toxicity. Intralipid appears to act initially as a vehicle that carries the stimulant drug away from heart and brain to less well-perfused organs (scavenging mechanism) and then, with a sufficient drop in the caffeine concentration, possibly as a tonic to the depressed heart.

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“…One consideration for rescuing such patients from prolonged superwarfarin toxicity is administering an early infusion of lipid emulsion (ILE), a simple intervention that can be accomplished rapidly, on a large scale, and with readily available technology. ILE is a new approach to treating lipophilic drug overdose that was first developed as a treatment for local anesthetic systemic toxicity (LAST) . It has shown reliable efficacy for this indication in both experimental models and the clinic, where several case reports describe rapid reversal of cardiovascular instability following treatment with lipid emulsion.…”

Section: Countermeasures For Superwarfarin Poisoning: Lipid Emulsionmentioning

confidence: 99%

The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures

Feinstein

Akpa

Ayee

et al. 2016

Annals of the New York Academy of Sciences

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Superwarfarins were developed following the emergence of warfarin resistance in rodents. Superwarfarins have much longer half-lives and stronger affinity to vitamin K epoxide reductase versus warfarin, and therefore can cause death in warfarin-resistant rodents. By the mid-1970s, the superwarfarins brodifacoum (BDF) and difenacoum (DiF) were the most widely used rodenticides throughout the world. Unfortunately, increased use was accompanied by a rise in accidental poisonings, reaching >16,000 per year in the United States. Risk of exposure has become a concern since large quantities, up to hundreds of kilograms of rodent bait, are applied by aerial dispersion over regions with rodent infestations. Reports of intentional use of superwarfarins in civilian and military scenarios raises the specter of larger incidents or mass casualties. Unlike warfarin overdose, for which 1–2 days of treatment with vitamin K is effective, treatment of superwarfarin poisoning with vitamin K is limited by extremely high cost and can require daily treatment for a year or longer. Furthermore, superwarfarins have actions that are independent of their anticoagulant effects, including both vitamin K–dependent and –independent effects, which are not mitigated by vitamin K therapy. In this review, we will summarize superwarfarin development, biology and pathophysiology, their threat as weapons, and possible therapeutic approaches.

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Past, Present, and Future of Lipid Resuscitation Therapy

Cited by 42 publications

References 195 publications

Knowledge of the Research Assistants Regarding Local Anaesthetics and Toxicity

Knowledge of the Research Assistants Regarding Local Anaesthetics and Toxicity

Intralipid in acute caffeine intoxication: a case report

The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures

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