Local anaesthetic systemic toxicity treated with intravenous lipid emulsion: ineffective treatment or selection of an inadequate lipid rescue dose?

2011 ◽  
Vol 28 (5) ◽  
pp. 390-391 ◽  
Author(s):  
David Roy Uncles ◽  
Johann W Willers ◽  
Theophilus L Samuels ◽  
Abhijoy Chaklader
Keyword(s):  
Local Anaesthetic ◽  
Lipid Emulsion ◽  
Systemic Toxicity ◽  
Intravenous Lipid Emulsion ◽  
Rescue Dose ◽  
Lipid Rescue ◽  
Selection Of

scholarly journals An In Vitro Analysis of the Effects of Intravenous Lipid Emulsion on Free and Total Local Anaesthetic Concentrations in Human Blood and Plasma

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Louise Ann Clark ◽  
Jochen Beyer ◽  
Andis Graudins
Keyword(s):  
Blood Plasma ◽  
Human Blood ◽  
Local Anaesthetic ◽  
Whole Blood ◽  
Lipid Emulsion ◽  
Equilibrium Dialysis ◽  
Human Blood Plasma ◽  
Intravenous Lipid Emulsion ◽  
Vitro Effect

Background. Intravenous lipid emulsion (ILE) is recommended as a “rescue” treatment for local anaesthetic (LA) toxicity. A purported mechanism of action suggests that lipophilic LAs are sequestered into an intravascular “lipid-sink,” thus reducing free drug concentration. There is limited data available correlating the effects of ILE on LAs.Aims. To compare the in vitro effect of ILE on LA concentrations in human blood/plasma and to correlate this reduction to LA lipophilicity.Method. One of four LAs (bupivacaine-most lipophilic-4 mg/L, ropivacaine-6 mg/L, lignocaine-14 mg/L, and prilocaine-least lipophilic-7 mg/L) was spiked into plasma or whole blood. ILE or control-buffer was added. Plasma was centrifuged to separate ILE and total-LA concentration assayed from the lipid-free fraction. Whole blood underwent equilibrium dialysis and free-LA concentration was measured. Percent reduction in LA concentration from control was compared between the LAs and correlated with lipophilicity.Results. ILE caused a significant reduction in total and free bupivacaine concentration compared with the other LAs. Ropivacaine had the least reduction in concentration, despite a lipophilicity similar to bupivacaine. The reduction in LA concentration correlated to increasing lipophilicity when ropivacaine was excluded from analysis.Conclusion. In this first in vitro model assessing both free- and total-LA concentrations exposed to ILE in human blood/plasma, ILE effect was linearly correlated with increasing lipophilicity for all but ropivacaine.

scholarly journals Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics

2021 ◽  
Vol 8 ◽  
Author(s):  
Yang Liu ◽  
Jing Zhang ◽  
Peng Yu ◽  
Jiangfeng Niu ◽  
Shuchun Yu
Keyword(s):  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Life Support ◽  
Clinical Symptoms ◽  
Advanced Cardiac Life Support ◽  
Systemic Toxicity ◽  
The Body ◽  
Research Progress ◽  
Intravenous Lipid Emulsion ◽  
Perioperative Analgesia

Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. Finally, the review presents key issues in lipid therapy. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist; therefore, ILE requires a high degree of attention during use. More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future.

scholarly journals Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Liana Maria Torres de Araújo Azi ◽  
Diego Grimaldi Figueroa ◽  
Ana Amélia Souza Simas
Keyword(s):  
Cardiac Arrest ◽  
Early Diagnosis ◽  
Paediatric Patient ◽  
Local Anaesthetic ◽  
Lipid Emulsion ◽  
Local Anaesthetics ◽  
Favourable Outcome ◽  
Intravenous Lipid Emulsion ◽  
Intraosseous Injection

We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

scholarly journals Lipid Emulsion for Local Anesthetic Systemic Toxicity

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Sarah Ciechanowicz ◽  
Vinod Patil
Keyword(s):  
Local Anesthetic ◽  
Local Anaesthetic ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Convincing Evidence ◽  
Systemic Toxicity ◽  
Initial Management ◽  
Preventative Measures ◽  
Accidental Overdose ◽  
Local Anesthetic Systemic Toxicity

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.

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Anaesthesia ◽  
2021 ◽  
Vol 76 (S1) ◽  
pp. 27-39
Author(s):  
A. J. R. Macfarlane ◽  
M. Gitman ◽  
K. J. Bornstein ◽  
K. El‐Boghdadly ◽  
G. Weinberg
Keyword(s):  
Local Anaesthetic ◽  
Systemic Toxicity ◽  
Narrative Review
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