scholarly journals Dosage of Lipid Emulsions as an Antidote to Lipid-Soluble Substances

Folia Medica ◽  
2021 ◽  
Vol 63 (6) ◽  
pp. 913-918
Author(s):  
Gabriela Kehayova ◽  
Snezha Zlateva ◽  
Petko Marinov
Keyword(s):  
Regional Anesthesia ◽  
Low Dose ◽  
Haemodynamic Instability ◽  
High Dose ◽  
Lipid Emulsions ◽  
Lipophilic Drug ◽  
Local Anesthetic Systemic Toxicity ◽  
American Society ◽  
Naval Hospital ◽  
Statistical Functions

Introduction: Lipid emulsions are increasingly used as an antidote to lipophilic drug intoxications. The dose recommended by the American Society of Regional Anesthesia is used primarily for the treatment of local anesthetic systemic toxicity. There is insufficient information about what the dose of lipid emulsions (LE) should be in other intoxications depending on their severity. Aim: To determine the LE dose in a shock or haemodynamic instability in patients with acute exogenous intoxications treated with LE. Materials and methods: Forty-nine patients with acute lipophilic drug intoxications were treated with LE in the Clinic of Toxicology at the Naval Hospital in Varna. Statistical analysis was performed using the statistical functions of Excel 2016 and the Statistica 7.0 software package. Results: The percentage of patients receiving a low dose of LE of 0.3 ml/kg (93.87%) was significantly higher than the percentage of patients treated with a medium (2.04%) and a high dose (4.08%) of LF. The high dose of LE of 1.5 ml/kg recommended by the American Society of Regional Anesthesia was administered to two patients (4.08%). In severe intoxications with exotoxic shock, the rate of LE administration varies from 20 ml/h to 40 ml/h. Conclusions: In severe intoxications with cardiotoxic syndrome and haemodynamic instability, LE should be used in the dose as suggested by the American Society of Regional Anesthesia. It is possible to use lower doses of LE in the range of 0.3–0.6 ml/kg in all moderate poisonings administered by continuous intravenous infusion for 12-24-48 hours. No side effects were observed at these doses.

scholarly journals The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity

2018 ◽  
Vol 43 (2) ◽  
pp. 113-123 ◽  
Author(s):  
Joseph M. Neal ◽  
Michael J. Barrington ◽  
Michael R. Fettiplace ◽  
Marina Gitman ◽  
Stavros G. Memtsoudis ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Systemic Toxicity ◽  
Pain Medicine ◽  
The Third ◽  
Practice Advisory ◽  
Local Anesthetic Systemic Toxicity ◽  
American Society

scholarly journals American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version

2020 ◽  
Vol 46 (1) ◽  
pp. 81-82
Author(s):  
Joseph M Neal ◽  
Erin J Neal ◽  
Guy L Weinberg
Keyword(s):  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Medical Knowledge ◽  
User Feedback ◽  
Systemic Toxicity ◽  
Simulation Studies ◽  
Pain Medicine ◽  
Cognitive Aids ◽  
Local Anesthetic Systemic Toxicity ◽  
American Society

The American Society of Regional Anesthesia and Pain Medicine (ASRA) periodically updates its practice advisories and associated cognitive aids. The 2020 version of the ASRA Local Anesthetic Systemic Toxicity checklist was created in response to user feedback, simulation studies and advances in medical knowledge. This report presents the 2020 version and discusses the rationale for its update.

Opioid-sparing Effects of a Low-dose Infusion of Naloxone in Patient-administered Morphine Sulfate 

1997 ◽  
Vol 87 (5) ◽  
pp. 1075-1081 ◽  
Author(s):  
Tong J. Gan ◽  
Brian Ginsberg ◽  
Peter S. A. Glass ◽  
Jennifer Fortney ◽  
Rajiv Jhaveri ◽  
...  
Keyword(s):  
Side Effects ◽  
Respiratory Rate ◽  
Low Dose ◽  
High Dose ◽  
General Anesthetic ◽  
Dose Infusion ◽  
Chi Squared ◽  
Sedation Scores ◽  
American Society ◽  
Postanesthetic Care Unit

Background A naloxone infusion is effective in reducing epidural and intrathecal opioid-related side effects. The use of naloxone infusion concomitant with intravenous morphine patient-controlled analgesia (PCA) has not been evaluated, probably because of an expected direct antagonism of the systemic opioid effect. The authors compared the incidence of morphine-related side effects and the quality of analgesia from two small doses of naloxone infusion. Methods Sixty patients classified as American Society of Anesthesiologists physical status 1, 2, or 3 who were scheduled for total abdominal hysterectomies were enrolled in the study. Patients received a standardized general anesthetic. In the postanesthetic care unit, patients received morphine as a PCA. They were randomized to receive either 0.25 microg x kg(-1) x h(-1) naloxone (low dose), 1 microg x kg(-1) x h(-1) (high dose), or saline (placebo) as a continuous infusion. Verbal rating scores for pain, nausea, vomiting, and pruritus; sedation scores; requests for antiemetic; and morphine use were recorded for 24 h. Blood pressure, respiratory rate, and oxyhemoglobin saturation were also monitored. Results Sixty patients completed the study. Both naloxone doses were equally effective in reducing the incidence of nausea, vomiting, and pruritus compared with placebo (P < 0.05 by the chi-squared test). There was no difference in the verbal rating scores for pain between the groups. The cumulative morphine use was the lowest in the low-dose group (42.3 +/- 24.1 mg; means +/- SD) compared with the placebo (59.1 +/- 27.4 mg) and high-dose groups (64.7 +/- 33.0 mg) at 24 h (P < 0.05 by analysis of variance). There was no incidence of respiratory depression (<8 breaths/min) and no difference in sedation scores, antiemetic use, respiratory rate, and hemodynamic parameters among the groups. Conclusions Naloxone is effective in preventing PCA opioid-related side effects. Naloxone infusion at 0.25 microg x kg(-1) x h(-1) not only attenuates these side effects but appears to reduce postoperative (beyond 4-8 h) opioid requirements. This dosing regimen can be prepared with 400 microg naloxone in 1,000 ml crystalloid given in 24 h to a patient weighing 70 kg.

Local Anesthesia Systemic Toxicity

2017 ◽  
Author(s):  
Joel Barton ◽  
Gavin Martin
Keyword(s):  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Point Of Care ◽  
Systemic Toxicity ◽  
Systems Management ◽  
Anesthetic Agents ◽  
Practice Advisory ◽  
Life Threatening ◽  
Local Anesthetic Systemic Toxicity ◽  
American Society

Regional anesthesia can deliver multiple benefits to patients undergoing surgery. However, administering even appropriate doses of local anesthetic agents for regional anesthesia can be life threatening, and the risks must be well understood. Local anesthetic systemic toxicity (LAST) is a spectrum or sequence of symptoms and dysfunction that affects the nervous and cardiopulmonary systems. Management of LAST revolves around recognition, supportive care, and, specifically, administration of lipid emulsion. The American Society of Regional Anesthesia practice advisory for management of LAST is an excellent point-of-care reference for anesthesiologists practicing regional anesthesia.

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