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Intralipids and local anesthetics

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https://www.readbyqxmd.com/read/27608281/evidence-based-recommendations-on-the-use-of-intravenous-lipid-emulsion-therapy-in-poisoning
#1
Sophie Gosselin, Lotte C G Hoegberg, Robert S Hoffman, Andis Graudins, Christine M Stork, Simon H L Thomas, Samuel J Stellpflug, Bryan D Hayes, Michael Levine, Martin Morris, Andrea Nesbitt-Miller, Alexis F Turgeon, Benoit Bailey, Diane P Calello, Ryan Chuang, Theodore C Bania, Bruno Mégarbane, Ashish Bhalla, Valéry Lavergne
BACKGROUND: Although intravenous lipid emulsion (ILE) was first used to treat life-threatening local anesthetic (LA) toxicity, its use has expanded to include both non-local anesthetic (non-LA) poisoning and less severe manifestations of toxicity. A collaborative workgroup appraised the literature and provides evidence-based recommendations for the use of ILE in poisoning. METHODS: Following a systematic review of the literature, data were summarized in four publications: LA and non-LA poisoning efficacy, adverse effects, and analytical interferences...
September 8, 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27404223/effect-of-intralipid%C3%A2-on-the-dose-of-ropivacaine-or-levobupivacaine-tolerated-by-volunteers-a-clinical-and-pharmacokinetic-study
#2
Pauline Dureau, Beny Charbit, Nathalie Nicolas, Dan Benhamou, Jean-Xavier Mazoit
BACKGROUND: Rapid intravenous administration of lipid emulsion has become the standard treatment of severe local anesthetic systemic toxicity. This experiment in volunteers aimed at determining the effect of Intralipid® administration on the time to neurologic symptoms. METHODS: Ropivacaine or levobupivacaine was infused intravenously in 16 volunteers (8 mg/min up to 120 mg) with 120 ml Intralipid® 20% (Fresenius, Paris France) or placebo infused at T + 2 min)...
September 2016: Anesthesiology
https://www.readbyqxmd.com/read/27389379/intralipid-emulsion-rescue-therapy-emerging-therapeutic-indications-in-medical-practice
#3
Sam H Muller, James H Diaz, Alan David Kaye
Intralipid emulsion therapy is well-established for the treatment of local-anesthetic systemic toxicities. In recent years, its role has expanded as an important therapeutic agent in the reversal of other types of drug overdoses, including certain types of antipsychotics, antidepressants, antiarrhythmics, and calcium channel blockers. A literature review identified thirty-one case reports including forty-nine separate drug overdose cases involving ten separate drug classes which were successfully reversed with Intralipid...
May 2016: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/27290983/lipid-rescue-in-children-the-prompt-decision
#4
Ramón Eizaga Rebollar, María V García Palacios, Javier Morales Guerrero, Luis M Torres Morera
We report the case of a 17-month-old child who underwent laparotomy under general anesthesia and caudal block. Electrocardiogram ST-T changes were observed after local anesthetic injection. The prompt use of Intralipid 30% was successful in normalizing ECG alterations. Our experience is consistent with previous literature, mainly carried out in adults. Thereby, we conduct a brief review of the subject in pediatrics. As a major conclusion, we strongly recommend the "fast-track" lipid rescue as soon as this severe complication is detected...
August 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27272169/intralipid-in-acute-caffeine-intoxication-a-case-report
#5
Luisa Muraro, Laura Longo, Federico Geraldini, Andrea Bortot, Andrea Paoli, Annalisa Boscolo
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...
October 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27224931/the-effect-of-lipid-emulsion-on-pharmacokinetics-of-bupivacaine-in-rats-long-chain-triglyceride-versus-long-and-medium-chain-triglyceride
#6
Wan Tang, Quanguang Wang, Kejian Shi, Jiaojiao Dong, Shengxian Lin, Shishi Zhao, Cong Wu, Yun Xia, Thomas J Papadimos, Xuzhong Xu
BACKGROUND: Lipid infusions have been proposed to treat local anesthetic-induced cardiac toxicity. This study compared the effects of long-chain triglyceride (LCT) emulsions with those of long- and medium-chain triglyceride (LCT/MCT) emulsions on the pharmacokinetics of bupivacaine in a rat model. METHODS: After administration of intravenous infusion of bupivacaine at 2 mg·kg·min for 5 minutes in Sprague-Dawley (SD) rats, either Intralipid 20%, an LCT emulsion (LCT group, n = 6), or Lipovenoes 20%, an LCT/MCT emulsion (LCT/MCT group, n = 6), was infused at 2mg·kg·min for 5 minutes...
May 24, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27222493/the-effects-of-intravenous-lipid-emulsion-on-hemodynamic-recovery-and-myocardial-cell-mitochondrial-function-after-bupivacaine-toxicity-in-anesthetized-pigs
#7
J A Heinonen, A A Schramko, M B Skrifvars, E Litonius, J T Backman, E Mervaala, P H Rosenberg
Local anesthetic toxicity is thought to be mediated partly by inhibition of cardiac mitochondrial function. Intravenous (i.v.) lipid emulsion may overcome this energy depletion, but doses larger than currently recommended may be needed for rescue effect. In this randomized study with anesthetized pigs, we compared the effect of a large dose, 4 mL/kg, of i.v. 20% Intralipid(®) (n = 7) with Ringer's acetate (n = 6) on cardiovascular recovery after a cardiotoxic dose of bupivacaine. We also examined mitochondrial respiratory function in myocardial cell homogenates analyzed promptly after needle biopsies from the animals...
May 24, 2016: Human & Experimental Toxicology
https://www.readbyqxmd.com/read/26885303/lipofundin%C3%A2-mct-lct-20-increase-left-ventricular-systolic-pressure-in-an-ex-vivo-rat-heart-model-via-increase-of-intracellular-calcium-level
#8
Jiyoung Park, Yeon A Kim, Jeong Yeol Han, Sangkyu Jin, Seong-Ho Ok, Ju-Tae Sohn, Heon-Keun Lee, Young-Kyun Chung, Il-Woo Shin
BACKGROUND: Lipid emulsions have been used to treat various drug toxicities and for total parenteral nutrition therapy. Their usefulness has also been confirmed in patients with local anesthetic-induced cardiac toxicity. The purpose of this study was to measure the hemodynamic and composition effects of lipid emulsions and to elucidate the mechanism associated with changes in intracellular calcium levels in myocardiocytes. METHODS: We measured hemodynamic effects using a digital analysis system after Intralipid® and Lipofundin® MCT/LCT were infused into hearts hanging in a Langendorff perfusion system...
February 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/26602425/lidocaine-induced-cardiac-arrest-in-the-emergency-department-effectiveness-of-lipid-therapy
#9
Kevin James Tierney, Tiffany Murano, Brenda Natal
BACKGROUND: Local anesthetics are commonly used in the emergency department (ED). Overdoses can lead to disastrous complications including cardiac toxicity and arrest. Recognition of local anesthetic systemic toxicity (LAST) is important; however, prevention is even more critical. Knowledge of proper lidocaine dosage can prevent LAST. LAST may be effectively treated with lipid emulsion therapy. Although the mechanism is not well understood, its use may have a profound impact on morbidity and mortality...
January 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/26118736/electrophysiological-haemodynamic-and-mitochondrial-alterations-induced-by-levobupivacaine-during-myocardial-ischemia-in-a-pig-model-protection-by-lipid-emulsions
#10
Zahida Mamou, Jacques Descotes, Philippe Chevalier, Bernard Bui-Xuan, Caroline Romestaing, Quadiri Timour
Accidental intravascular or high-dose injection of local anesthetics (LA) can result in serious, potentially life-threatening complications. Indeed, adequate supportive measures and the administration of lipid emulsions are required in such complications. The study's objectives were threefold: (i) evaluate the myocardial toxicity of levobupivacaine when administered intravenously; (ii) investigate levobupivacaine toxicity on cardiomyocytes mitochondrial functions and cellular structure; (iii) assess the protective effects of a lipid emulsion in the presence or absence of myocardial ischemia...
October 2015: Fundamental & Clinical Pharmacology
https://www.readbyqxmd.com/read/26049929/clinical-applications-of-intravenous-lipid-emulsion-therapy
#11
REVIEW
Sam H Muller, James H Diaz, Alan David Kaye
Intravenous lipid emulsion (ILE; Intralipid) therapy, a standard treatment in local anesthetic toxicity, has demonstrated therapeutic efficacies for a number of different drug class-mediated toxicities. Some of these varied drug groups include antipsychotics, antidepressants, antiarrhythmics, and calcium channel blockers. To meet the objective of describing the growing number of indications for Intralipid therapy and any diverse effects and/or failures of Intralipid therapy in reversing multiple drug toxicities, we queried several Internet search engines with the key words "intravenous lipid emulsion therapy," "Intralipid," "lipid emulsion," and "local anesthetic systemic toxicity," resulting in the identification of 31 case reports for descriptive analysis...
December 2015: Journal of Anesthesia
https://www.readbyqxmd.com/read/26035145/lipid-rescue-in-a-pediatric-burn-patient
#12
Matthew Musielak, John McCall
Pain control is a major concern for patients suffering burns. The addition of bupivacaine to the donor site infiltration solution containing epinephrine could offer a safe and effective means to treat postanesthesia pain. Despite the addition of epinephrine to localize the effects, systemic absorption occurs, and there exists the possibility of inadvertent intravascular injection, with potential CNS and cardiac toxicity. The patient is a 6-year-old boy who sustained flame burns to bilateral lower extremities and buttocks...
July 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/25993392/involvement-of-opioid-receptors-in-the-lipid-rescue-of-bupivacaine-induced-cardiotoxicity
#13
Parisa Partownavid, Salil Sharma, Jignyuan Li, Soban Umar, Siamak Rahman, Mansoureh Eghbali
BACKGROUND: Lipid emulsion (LE) has been successfully used for resuscitation of local anesthetic cardiotoxicity caused by bupivacaine overdose. Opioid receptors have been shown to play a key role in cardio protection. We explored whether this rescue action of LE is mediated through opioid receptors. METHODS: Asystole was induced by bupivacaine (10 mg/kg over 20 seconds, IV) in young male Sprague-Dawley rats, and resuscitation with LE (intralipid 20%; 5 mL/kg bolus and 0...
August 2015: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/25908403/cardiac-depression-induced-by-cocaine-or-cocaethylene-is-alleviated-by-lipid-emulsion-more-effectively-than-by-sulfobutylether-%C3%AE-cyclodextrin
#14
Michael R Fettiplace, Adrian Pichurko, Richard Ripper, Bocheng Lin, Katarzyna Kowal, Kinga Lis, David Schwartz, Douglas L Feinstein, Israel Rubinstein, Guy Weinberg
OBJECTIVES: Cocaine intoxication leads to over 500,000 emergency department visits annually in the United States and ethanol cointoxication occurs in 34% of those cases. Cardiotoxicity is an ominous complication of cocaine and cocaethylene overdose for which no specific antidote exists. Because infusion of lipid emulsion (Intralipid) can treat lipophilic local anesthetic toxicity and cocaine is an amphipathic local anesthetic, the authors tested whether lipid emulsion could attenuate cocaine cardiotoxicity in vivo...
May 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25842943/-systemic-toxicity-of-local-anaesthetics-in-children
#15
REVIEW
O S Geodakian
The article deals with an analysis of the publications devoted of local anaesthetics' systemic toxicity (LAST) due to regional anaesthesia and symptoms of this potentially lethal complication. The review discusses features of systemic absorption and forms of local anaesthetics' neurotoxicity and cardiotoxicity in children, including newborns, differences of clinical signs of the LAST in adults and children and dosage of racemic bupivacaine. Moreover, the article deals with a modified treatment protocol for LAST and a method of lipid resuscitation with 20% lipid emulsion in the form of Intralipid...
September 2014: Anesteziologiia i Reanimatologiia
https://www.readbyqxmd.com/read/25767725/intralipid-therapy-for-inadvertent-peripheral-nervous-system-blockade-resulting-from-local-anesthetic-overdose
#16
Ihab Kamel, Gaurav Trehan, Rodger Barnette
Although local anesthetics have an acceptable safety profile, significant morbidity and mortality have been associated with their use. Inadvertent intravascular injection of local anesthetics and/or the use of excessive doses have been the most frequent causes of local anesthetic systemic toxicity (LAST). Furthermore, excessive doses of local anesthetics injected locally into the tissues may lead to inadvertent peripheral nerve infiltration and blockade. Successful treatment of LAST with intralipid has been reported...
2015: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/25536745/efficacy-of-resuscitation-with-intralipid-in-a-levobupivacaine-induced-cardiac-arrest-model
#17
Murat Karcioğlu, Kasim Tuzcu, Fatih Sefil, Işil Davarci, Suzan Aydin, Ali Sari, Akin Aydoğan, Raif Özden
AIM: Cardiac toxicity due to the administration of local anesthetics may be fatal. In this study, we evaluated the efficacy of a 20% lipid solution combined with epinephrine in a levobupivacaine-induced cardiac arrest model. MATERIALS AND METHODS: A total of 14 New Zealand rabbits were sedated and mechanically ventilated. Asystole was induced with intravenous levobupivacaine injection. The rabbits were randomized into groups receiving the same volume of either 0...
2014: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/25271183/lipid-emulsion-use-precluding-renal-replacement-therapy
#18
Betzaida Rodríguez, Andrew Wilhelm, Kenneth E Kokko
BACKGROUND: Intralipid emulsion (ILE) is a nutritional fatty acid supplementation that is emerging as a potential therapy for local anesthetic systemic toxicity and is also being considered as a therapy for other lipophilic medication intoxications. Isolated reports of pulmonary edema or severe lipemia exist as a complication of therapy. CASE REPORT: A 26-year-old hypertensive, male, kidney transplant recipient presented to an outside emergency department (ED) after an intentional overdose of his medications (ie, amlodipine, metoprolol, lisinopril)...
December 2014: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/25207682/intravenous-lipid-emulsion-given-to-volunteers-does-not-affect-symptoms-of-lidocaine-brain-toxicity
#19
RANDOMIZED CONTROLLED TRIAL
Juho A Heinonen, Erik Litonius, Tapani Salmi, Juhani Haasio, Pekka Tarkkila, Janne T Backman, Per H Rosenberg
Intravenous lipid emulsion has been suggested as treatment for local anaesthetic toxicity, but the exact mechanism of action is still uncertain. Controlled studies on the effect of lipid emulsion on toxic doses of local anaesthetics have not been performed in man. In randomized, subject-blinded and two-phase cross-over fashion, eight healthy volunteers were given a 1.5 ml/kg bolus of 20% Intralipid(®) (200 mg/ml) or Ringer's acetate solution intravenously, followed by a rapid injection of lidocaine 1.0 mg/kg...
April 2015: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/25192265/local-anaesthetics-10-essentials
#20
REVIEW
Philipp Lirk, Susanne Picardi, Markus W Hollmann
This review seeks to address 10 essential questions regarding the clinical use of local anaesthetics. Each local anaesthetic has distinctive physicochemical properties but with the same mode of action; they block voltage-gated sodium channels in the axon. Sodium channel block is brought about by a conformational change and the creation of a positive charge in the channel pore. Different local anaesthetics can reach the local anaesthetic binding site in the axon from the cytoplasmic compartment (classic hydrophilic pathway), or directly via its lipid membrane (hydrophobic pathway), or can enter via large-pore channels (alternative hydrophilic pathway)...
November 2014: European Journal of Anaesthesiology
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