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.

Local Anesthetics for Neuraxial and Regional Techniques

2018 ◽  
Author(s):  
Michael J Schontz ◽  
Krystina Geiger
Keyword(s):  
Pain Relief ◽  
Adverse Effects ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Systemic Toxicity ◽  
Duration Of Action ◽  
Liposomal Bupivacaine ◽  
Provide Pain Relief ◽  
Local Anesthetic Systemic Toxicity

Local anesthetics are used with neuraxial and regional techniques to provide pain relief, most commonly postoperatively. Each agent is a sodium-channel blocker, although each agent differs in onset of action, potency, duration of action, and safety profile. Chemical structure and lipophilicity are the main determinants of these characteristics. The agents may be used alone or in combination with an additive which alters the local anesthetic’s properties . Clinically, local anesthetics provide pain relief in a multimodal approach. This reduces opiate consumption, opiate-related adverse effects, and length of stay. Additional benefits when using neuraxial techniques include decreases in mortality, venous thromboembolism, myocardial infarction, pneumonia, respiratory depression, and duration of ileus. Although there are many adverse effects, the most serious include neurologic and cardiovascular. Seizures and cardiac arrest may result from local anesthetic systemic toxicity when systemic levels are elevated or the patient is predisposed. Dose adjustment, removal, or reversal of the agent may be clinically indicated. Lipid emulsion therapy is a reversal agent which acts as a sequestering vehicle for the local anesthetic. Liposomal bupivacaine, the newest formulation of local anesthetic, may provide an increased duration of action compared with standard formulations, although more evidence is needed. This review contains 5 figures, 5 tables, and 59 references. Keywords: amide, ester, epidural, local anesthetic, local anesthetic systemic toxicity, lipid emulsion therapy, liposomal bupivacaine, peripheral nerve block

scholarly journals Nearly Fatal Hydroxychloroquine Overdose Successfully Treated with Midazolam, Propofol, Sodium Bicarbonate, Norepinephrine, and Intravenous Lipid Emulsion

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Goswin Onsia ◽  
Sarah Bots
Keyword(s):  
Sodium Bicarbonate ◽  
Lipid Emulsion ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Cardiac Monitoring ◽  
High Dose ◽  
Epinephrine Infusion ◽  
Intravenous Lipid Emulsion

Background. In the context of the current COVID-19 pandemic, there has been renewed interest in the drug hydroxychloroquine. However, clinicians should be aware of the dangers of hydroxychloroquine intoxication, an insufficiently studied condition. Case Report. We present a case of autointoxication with 20 g hydroxychloroquine in a 35-year-old woman. Cardiac monitoring showed ventricular arrhythmias for which high-dose midazolam and propofol were initiated, resulting in a brief normalization of the cardiac rhythm. Because of the reoccurrence of these arrhythmias, intravenous lipid emulsion was administered with fast cardiac stabilization. Treatment with continuous norepinephrine, potassium chloride/phosphate, and sodium bicarbonate was initiated. On day 6, she was extubated and after 11 days, she was discharged from the hospital without complications. Conclusion. Since high-quality scientific evidence is lacking, treatment options are based on experience in chloroquine toxicity. Activated charcoal is advised if the patient presents early. Sedation with diazepam, early ventilation, and continuous epinephrine infusion are considered effective in treating severe intoxication. Caution is advised when substituting potassium. Despite the lack of formal evidence, sodium bicarbonate appears to be useful and safe in case of QRS widening. Intravenous lipid emulsion, with or without hemodialysis, remains controversial but appears to be safe. As a last resort, extracorporeal life support might be considered in case of persisting hemodynamic instability.

scholarly journals A Mixed (Long- and Medium-chain) Triglyceride Lipid Emulsion Extracts Local Anesthetic from Human Serum In Vitro  More Effectively than a Long-chain Emulsion

2012 ◽  
Vol 116 (2) ◽  
pp. 334-339 ◽  
Author(s):  
Weiming Ruan ◽  
Deborah French ◽  
Alicia Wong ◽  
Kenneth Drasner ◽  
Alan H. B. Wu
Keyword(s):  
Human Serum ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Life Support ◽  
Medium Chain Triglyceride ◽  
In Vitro Study ◽  
Current Data ◽  
Long Chain Triglycerides ◽  
Long Chain

Background Lipid emulsion infusion reverses cardiac toxicity of local anesthetics. The predominant effect is likely creation of a "lipid sink." This in vitro study determined the extent to which Intralipid® (Fresenius Kabi, Uppsala, Sweden) and Lipofundin® (B. Braun Melsungen AG, Melsungen, Germany) sequester anesthetics from serum, and whether it varies with pH. Methods Bupivacaine, ropivacaine, and mepivacaine were added to human drug-free serum (pH 7.4) at 10 μg/ml. The lipid emulsions were added, and the mixture shaken and incubated at 37°C. Lipid was removed by ultracentrifugation and drug remaining in the serum measured. Additional experiments were performed using 100 μg/ml bupivacaine and at pH 6.9. Results Lipofundin® extracted all three anesthetics to a greater extent than Intralipid® (34.7% vs..22.3% for bupivacaine, 25.8% vs..16.5% for ropivacaine, and 7.3% vs..4.7% for mepivacaine). By increasing either concentration of bupivacaine or lipid, there was an increase in drug extraction from serum. Adjusting the pH to 6.9 had no statistically significant effect on the percentage of bupivacaine sequestered. Conclusions Bupivacaine, ropivacaine, and mepivacaine were sequestered to an extent consistent with their octanol:water partition constants (logP). In contrast with previous studies of extraction of lipids from buffer solutions, an emulsion containing 50% each of medium- and long-chain triglycerides extracted local anesthetics to a greater extent from human serum than one containing exclusively long-chain triglycerides, calling into question recent advanced cardiac life support guidelines for resuscitation from anesthetic toxicity that specify use of a long-chain triglyceride. The current data also do not support recent recommendations to delay administration until pH is normalized.

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

2016 ◽  
Vol 54 (3) ◽  
pp. 194-221 ◽  
Author(s):  
Michael Levine ◽  
Robert S. Hoffman ◽  
Valéry Lavergne ◽  
Christine M. Stork ◽  
Andis Graudins ◽  
...  
Keyword(s):  
Systematic Review ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Intravenous Lipid Emulsion ◽  
Non Local

Intravenous Lipid Emulsion for Management of Systemic Toxic Effects of Drugs

2016 ◽  
Vol 27 (4) ◽  
pp. 394-404 ◽  
Author(s):  
Jaclyn O’Connor ◽  
Suprat Saely Wilson
Keyword(s):  
Emergency Department ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Rescue Therapy ◽  
Hemodynamic Instability ◽  
The United States ◽  
Emergency Department Visits ◽  
Toxic Effects ◽  
Intravenous Lipid Emulsion ◽  
The Past

The incidence of toxic effects of drugs leading to emergency department visits has increased in the United States in the past several years. Most of these patients can be adequately managed by supportive care alone. However, pharmacological antidotes may be necessary, particularly in patients with hemodynamic instability. In severe cases refractory to conventional antidote therapy, rescue therapy with intravenous lipid emulsion (ILE) may be necessary. Traditionally, ILE has been used as an antidote of choice in treating toxic effects of local anesthetics. But data continue to emerge on the successful use of ILE to treat overdoses of drugs other than local anesthetics, particularly lipophilic medications. The recommended ILE dose is a 1.5 mL/kg bolus followed by infusion of 15 mL/kg per hour, with repeat dosing permissible for continued hemodynamic instability. Use of ILE should be considered early as a rescue therapy in the settings of lipophilic medication overdoses when cardiovascular compromise or cardiac arrest is present.

Venlafaxine Intoxication with Development of Takotsubo Cardiomyopathy: Successful Use of Extracorporeal Life Support, Intravenous Lipid Emulsion and Cytosorb®

2017 ◽  
Vol 40 (7) ◽  
pp. 358-360 ◽  
Author(s):  
Ines Schroeder ◽  
Michael Zoller ◽  
Matthias Angstwurm ◽  
Felix Kur ◽  
Lorenz Frey
Keyword(s):  
Suicide Attempt ◽  
Cardiogenic Shock ◽  
Young Patient ◽  
Takotsubo Cardiomyopathy ◽  
Therapeutic Dose ◽  
Lipid Emulsion ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Intravenous Lipid Emulsion ◽  
Multi Organ Dysfunction Syndrome

We describe a young patient who ingested 18 g (240 times the daily therapeutic dose) of venlafaxine in a suicide attempt. She developed severe cardiomyopathy in a takotsubo distribution causing cardiogenic shock and multi-organ dysfunction syndrome (MODS). She was successfully treated with intravenous lipid emulsion (ILE), extracorporeal life support (ECLS) and CytoSorb®. This is remarkable as, to the best of the authors’ knowledge, this is the highest amount of venlafaxine intake seen in the literature with a nonfatal outcome.

Management of Local Anesthetics Systemic Toxicity In A 78 Year Old Man Undergoing Remove Of Inplate

2021 ◽  
Vol 2 (3) ◽  
pp. 112-115
Author(s):  
Wike Yuliana ◽  
◽  
Heri Dwi Purnomo ◽  
Keyword(s):  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Vital Signs ◽  
Systemic Circulation ◽  
Open Reduction Internal Fixation ◽  
Systemic Toxicity ◽  
Clinical Practices ◽  
Normal Limits ◽  
Breath Sounds ◽  
Threatening Condition

Background: Local anesthetics have been widely used over the past 50 years in many clinical practices, ranging from emergency departments to operating rooms. Local anesthetics systemic toxicity (LAST) is a life-threatening condition when the effects of local anesthetics reach the systemic circulation with an incidence of 0.03% or 0.27 incidence of 1000 episodes of Peripheral nerve block (PNB). Case: We report a 78-year-old male who underwent of remove of inplate (ROI) and open reduction internal fixation (ORIF) reconstruction. Preoperative physical examination revealed GCS E4V5M6, blood pressure 195/76, other vital signs within normal limits, SpO2 99% in the supine position. On examination of the lungs, there were increased bronchial breath sounds and rough crackles, especially in the 2-5 left intercostal space. Other physical and laboratory examinations were within normal limits. The patient was hemodynamically stable after infusion lipid emulsion. The main principle of LAST management is to ensure adequate ventilation and organ perfusion with sufficient oxygen-rich blood to reach the brain, heart, and kidneys to prevent acidosis until lipid emulsion therapy. Conclusion: LAST management requires prompt and precise diagnosis and treatment to get a good outcome.

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