Systematic review of the effect of intravenous lipid emulsion therapy for non-local anesthetics toxicity

Levine, M.D. Norman; Hoffman, Robert S.; Lavergne, Valéry; Stork, Christine M.; Graudins, Andis; Chuang, Ryan; Stellpflug, Samuel J.; Morris, Martin; Miller-Nesbitt, Andrea; Gosselin, Sophie

doi:10.3109/15563650.2015.1126286

Cited by 98 publications

(61 citation statements)

References 148 publications

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“…13,14 The main CYP isoforms involved are CYP3A4 for lidocaine and bupivacaine and CYP1A2 for ropivacaine. CYP3A4 is not mature at birth but is partly replaced by CYP3A7.…”

Section: General Comments On the Use Of Las In Childrenmentioning

confidence: 99%

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia

Suresh

Ecoffey

Bösenberg

et al. 2018

Regional Anesthesia and Pain Medicine

113

129

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“…13,14 The main CYP isoforms involved are CYP3A4 for lidocaine and bupivacaine and CYP1A2 for ropivacaine. CYP3A4 is not mature at birth but is partly replaced by CYP3A7.…”

Section: General Comments On the Use Of Las In Childrenmentioning

confidence: 99%

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia

Suresh

Ecoffey

Bösenberg

et al. 2018

Regional Anesthesia and Pain Medicine

113

129

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“…ILE has been shown to be an effective antidote for intoxication caused by numerous lipophilic agents. The exact mechanism of action remains unknown, however, it is suspected that ILE serves as a “lipid sink” for fat‐soluble compounds, reducing the amount of free drug in circulation, thereby reducing the drug's toxic effects . Other proposed mechanisms include the “change in energy theory,” in which ILE provides enough fatty acid to facilitate myocardial fatty acid utilization, and/or inhibit endothelial nitric oxide synthase which decreases nitric oxide‐induced vasodilation .…”

Section: Discussionmentioning

confidence: 99%

Xylitol toxicosis and serotonin‐like syndrome occurring simultaneously in a dog secondary to ingestion of Natrol 5‐HTP Fast Dissolve Tablets

Ortolani¹,

Bellis²,

Griego³

2018

Clinical Case Reports

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“…[22][23][24][25][26][27][28][29][30][31][32] A recently published systematic review on the use of ILE in nonlocal anesthetic overdoses found current evidence to be heterogeneous and low quality. 33 Moreover, several publications have demonstrated adverse effects with its use, including interference with laboratory investigations such as the complete blood count (CBC) and electrolytes. [34][35][36][37][38][39][40][41][42][43] Although ILE use is well established in LAST, the effectiveness of ILE for non-LAST poisonings is still unclear.…”

Section: Importancementioning

confidence: 99%

A cohort study of unstable overdose patients treated with intravenous lipid emulsion therapy

Mithani

Dong

Wilmott

et al. 2016

CJEM

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Objectives: Intravenous lipid emulsion (ILE) has been used increasingly over the last decade for a range of drug overdoses. Although the use of ILE in local anesthetic toxicity (LAST) is well established, the hemodynamic effectiveness of ILE in non-LAST poisonings is still unclear. Thus, the primary objective of this study was to examine a cohort of poisoned patients in whom ILE was administered. Methods: Consecutive patients were identified by calls to a regional poison center from May 1, 2012 to May 30, 2014. Patients were enrolled if they ingested a drug, developed hemodynamic instability, failed conventional treatment, and received ILE therapy. Data were collected by medical record review. The primary outcome was the change in mean arterial pressure (MAP) in the first hour after ILE administration. Secondary outcomes included survival, length of stay, and the effect of drug class on patient outcome. Results: Thirty-six patients were enrolled. Agents ingested included calcium channel blockers and beta blockers (10/36, 27.8%), tricyclic antidepressants (5/36, 13.9%), bupropion (3/36, 8.3%), and antiepileptic agents (1/36, 2.8%). Seventeen patients (47.2%) ingested multiple agents. Twenty-five patients survived (69.0%). Overall, MAP increased by 13.79 mm Hg (95% CI 1.43-26.15); this did not meet our a priori definition of clinical significance. Conclusions: Our study did not find a clinically important improvement in MAP after ILE administration. Until future research is done to more definitively study its efficacy, ILE should remain a potential treatment option for hemodynamically unstable overdose patients only after conventional therapy has failed. RÉSUMÉObjectif: Le recours à l'émulsion lipidique intraveineuse (ELI) a connu une augmentation au cours de la dernière décennie dans le traitement de divers types de surdosage. Si l'utilisation de l'ELI dans le traitement de la toxicité des anesthésiques locaux est bien établie, l'efficacité hémodynamique de l'ELI dans les cas d'intoxication causée par d'autres substances que les anesthésiques locaux, elle, est incertaine. L'étude décrite ici avait donc pour objectif principal d'examiner une cohorte de patients intoxiqués, traités par une ELI. Méthode: Le repérage des patients consécutifs s'est fait à l'aide des appels reçus dans un centre antipoisons régional, du 1er mai 2012 au 30 mai 2014. Ont été retenus ceux qui avaient pris des médicaments, présentaient de l'instabilité hémodynamique, n'avaient pas réagi au traitement habituel et avaient été traités par une ELI. La collecte de données a été réalisée à l'aide des dossiers médicaux. Le principal critère d'évaluation consistait en la mesure des variations de la pression artérielle moyenne (PAM) au cours de la première heure suivant l'administration de l'ELI; les critères secondaires d'évaluation comprenaient la survie, la durée du séjour et l'effet de la classe de médicaments sur l'évolution de l'état de santé. Résultats: Ont participle à l'étude 36 patients. Différents types de médicaments avaient été ...

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Systematic review of the effect of intravenous lipid emulsion therapy for non-local anesthetics toxicity

Abstract: Despite the use of ILE for multiple substances in the treatment of patients with poisoning and overdose, the effect of ILE in various non-local anesthetic poisonings is heterogenous, and the quality of evidence remains low to very low.

Cited by 98 publications

References 148 publications

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia

Xylitol toxicosis and serotonin‐like syndrome occurring simultaneously in a dog secondary to ingestion of Natrol 5‐HTP Fast Dissolve Tablets

A cohort study of unstable overdose patients treated with intravenous lipid emulsion therapy

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