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Lipid emulsion resuscitation

Michael R Fettiplace, Daniel J McCabe
INTRODUCTION: The Lipid Emulsion Therapy workgroup, organized by the American Academy of Clinical Toxicology, recently conducted a systematic review, which subjectively evaluated lipid emulsion as a treatment for local anesthetic toxicity. We re-extracted data and conducted a meta-analysis of survival in animal models. METHODS: We extracted survival data from 26 publications and conducted a random-effect meta-analysis based on odds ratio weighted by inverse variance...
February 17, 2017: Clinical Toxicology
Philippe Le Fevre, Mark Gosling, Keyur Acharya, Andrew Georgiou
Amitriptyline and propranolol are life threatening in overdose. The efficacy of intravenous lipid emulsion (ILE) in tricyclic antidepressant and propranolol overdose is unclear. We report a dramatic response to ILE following pulseless electrical activity arrest due to mixed amitriptyline and propranolol overdose.
March 2, 2017: BMJ Case Reports
Zhe Chen, Zhousheng Jin, Yun Xia, Shishi Zhao, Xuzhong Xu, Thomas J Papadimos, Quanguang Wang
Lipid emulsion (LE) has been shown to be effective in the resuscitation of bupivacaine-induced cardiac arrest, but the precise mechanism of this action has not been fully elucidated. Pursuant to this lack of information on the mechanism in which LE protects the myocardium during bupivacaine-induced toxicity, we explored mitochondrial function and cell apoptosis. H9C2 cardiomyocytes were used in study. Cells were randomly divided in different groups and were cultivated 6 h, 12 h, and 24 h. The mitochondria were extracted and mitochondrial ATP content was measured, as was mitochondrial membrane potential, the concentration of calcium ion (Ca2+), and the activity of Ca2+-ATP enzyme (Ca2+-ATPase)...
November 2017: Drug Delivery
Gail K Wong, Carolyne Pehora, Mark W Crawford
BACKGROUND: The primary aim of this study was to evaluate the effect of acute administration of L-carnitine 100 mg·kg(-1) iv on susceptibility to bupivacaine-induced cardiotoxicity in rats. METHODS: In the first of two experiments, L-carnitine 100 mg·kg(-1) iv (n = 10) or saline iv (n = 10) was administered to anesthetized and mechanically ventilated Sprague-Dawley rats following which an infusion of bupivacaine 2.0 mg·kg(-1)·min(-1) iv was given until asystole occurred...
March 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Liana Maria Torres de Araújo Azi, Diego Grimaldi Figueroa, Ana Amélia Souza Simas
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.
2016: Case Reports in Anesthesiology
Mengxu Luo, Xia Yun, Chaoxing Chen, Nana Bao, Xiaona Feng, Linmin Pan, Zhousheng Jin, Cong Wu, Xianqin Wang, Thomas J Papadimos, Xuzhong Xu
BACKGROUND AND OBJECTIVES: Epinephrine is usually administered in concert with a lipid emulsion during local anesthetic toxicity. However, the timing and role of epinephrine administration in combination with a lipid emulsion remain unclear. Specifically, the temporal association of epinephrine and lipid emulsion administration with related changes in pulmonary vascular pressures that may lead to pulmonary edema and hemorrhage needs to be determined. METHODS: This study consisted of 2 parts, experiments A and B...
July 2016: Regional Anesthesia and Pain Medicine
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
Peter R Chai, Jason B Hack
CONTEXT: Intravenous lipid emulsion (ILE) is a potential antidote for severe overdose of certain lipophilic drugs. Cocaine overdose is often fatal and has no antidote. The use of ILE after cocaine-induced cardiac arrest has been suggested but is not well characterized. OBJECTIVE: The objective of the study is to determine if ILE would reverse cocaine-induced cardiac arrest in a rat model. MATERIALS AND METHODS: Twelve Sprague-Dawley rats with intra-arterial and intravenous access were sedated with isoflurane and split into 2 cocaine dose groups, then given either ILE or normal saline (NS) intravenously (IV)-group A, 7 animals received cocaine (10 mg/kg IV) with 6 of 7 given ILE (15 mg/kg IV) and 1 of 7 given NS (equal volume); group B, 5 animals received cocaine (5 mg/kg IV) with 3 of 5 given ILE (15 mg/kg IV) and 2 of 5 given NS (equal volume)...
August 2016: American Journal of Emergency Medicine
Lawrence V Fulton, Robert A Fabich, Jeevan Bhatta, Brandon Fletcher, Kirby Leininger, Kevin Lienesch, Thais A Rodriguez, Jennifer L Coyner, Arthur D Johnson, Joseph O'Sullivan
AIMS: The aim of this study was to investigate the effects of different treatment combinations on bupropion recovery as well as time to return of spontaneous circulation. METHODS: We conducted an eight group, randomized, experiment to evaluate combinations of epinephrine, vasopressin, and lipids on the restoration of cardiac function in Yorkshire pigs. After tracking the animals' baseline vitals for 10 minutes, we injected the animals with bupropion (35 mg/kg) and initiated a randomized protocol 2 minutes after cardiac arrest...
May 2016: Military Medicine
Benjamin Ramasubbu, David James, Andrew Scurr, Euan A Sandilands
A 28-year-old woman was admitted in a comatose state following ingestion of 5 g of amitriptyline. On arrival, there was intermittent seizure activity and a broad complex tachycardia on the ECG. Immediate resuscitation included 8 mg lorazepam, 2 L crystalloid fluid, 100 mL 8.4% sodium bicarbonate, 2 g of magnesium sulphate and lipid emulsion infusion. Despite this, the broad complex tachycardia persisted with haemodynamic instability. The case was discussed with the National Poisons Information Service, which advised further 8...
2016: BMJ Case Reports
Lawrence V Fulton, Jason Aitken, John Avery, Brooke Kahl, Abisai Negron, Barbara Chavez, Nicole Iosett, Don Johnson, Joseph O'Sullivan
OBJECTIVES: Venlafaxine overdose can lead to cardiovascular collapse that is difficult to resuscitate with traditional Advanced Cardiovascular Life Support protocols. Evidence has suggested that lipid emulsion infusion therapy has been successful in the treatment of antidepressant overdose. No studies have determined the optimal combination of lipid/advanced cardiovascular life support therapy for treatment. METHODS: This study was a prospective, experimental, between subjects design with a swine model investigating the effectiveness of drug combinations administered with cardiopulmonary resuscitation (CPR) postvenlafexine overdose...
April 2016: Military Medicine
G Rosenthal, W A Wetsch, T Neumann, S A Padosch, B W Böttiger, H E Marcus
PURPOSE: Toxic reactions to local anesthetics are rare but potentially lethal. In fact, animal studies and case reports demonstrate that the administration of lipid emulsions after initializing cardiopulmonary resuscitation is a promising treatment option. The aim of this study was to determine how many hospitals in Germany are prepared to treat toxic reactions to local anesthetics with lipid infusion and to identify how often and what type of toxic reactions occur and if treatment was successful...
April 2016: Der Anaesthesist
Jasmina Jović-Stosić, Vesna Putić, Dragan Zivanović, Milica Mladenov, Gordana Brajković, Snelana Djordjević
INTRODUCTION: Calcium channel blockers and beta-blockers are among the most frequently ingested cardiovascular drugs in self-poisoning causing significant mortality. Intravenous lipid emulsion (ILE) is reported as a potentially novel antidote for treatment of acute poisoning caused by some of these drugs. CASE REPORT: We presented two cases of poisoning with these drugs. The case 1, a 24-year-old woman ingested amplodipine, metformin and gliclazide for self-poisoning...
January 2016: Vojnosanitetski Pregled. Military-medical and Pharmaceutical Review
S J Rietjens, D W de Lange, D W Donker, J Meulenbelt
Calcium channel antagonists (CCAs) are widely used for different cardiovascular disorders. At therapeutic doses, CCAs have a favourable side effect profile. However, in overdose, CCAs can cause serious complications, such as severe hypotension and bradycardia. Patients in whom a moderate to severe intoxication is anticipated should be observed in a monitored setting for at least 12 hours if an immediate-release formulation is ingested, and at least 24 hours when a sustained-release formulation (or amlodipine) is involved, even if the patient is asymptomatic...
February 2016: Netherlands Journal of Medicine
Lotte C G Hoegberg, Theodore C Bania, Valéry Lavergne, Benoit Bailey, Alexis F Turgeon, Simon H L Thomas, Martin Morris, Andrea Miller-Nesbitt, Bruno Mégarbane, Sheldon Magder, Sophie Gosselin
BACKGROUND: Following national and regional recommendations, intravenous lipid emulsion (ILE) has become established in clinical practice as a treatment for acute local anesthetic (LA) toxicity, although evidence of efficacy is limited to animal studies and human case reports. A collaborative lipid emulsion workgroup was therefore established by the American Academy of Clinical Toxicology to review the evidence on the effect of ILE for LA toxicity. METHODS: We performed a systematic review of the literature published through 15 December 2014...
March 2016: Clinical Toxicology
Michael R Fettiplace, Katarzyna Kowal, Richard Ripper, Alexandria Young, Kinga Lis, Israel Rubinstein, Marcelo Bonini, Richard Minshall, Guy Weinberg
BACKGROUND: The impact of local anesthetics on the regulation of glucose homeostasis by protein kinase B (Akt) and 5'-adenosine monophosphate-activated protein kinase (AMPK) is unclear but important because of the implications for both local anesthetic toxicity and its reversal by IV lipid emulsion (ILE). METHODS: Sprague-Dawley rats received 10 mg/kg bupivacaine over 20 s followed by nothing or 10 ml/kg ILE (or ILE without bupivacaine). At key time points, heart and kidney were excised...
February 2016: Anesthesiology
Gangming Wu, Bin Sun, L I Liu, Jun Zhou, Liqun Mo, Changhe Ren, Cehua Ou
The aim of the present study was to investigate the effect of intravenously administered lipid emulsion on local anesthetic (LA)-induced central nervous system (CNS) toxicity. A total of 100 male Sprague Dawley rats were allocated at random into the following groups: Sham (A), lidocaine (B), levobupivacaine (C) and ropivacaine (D). Groups B-D were each subdivided into three subgroups: Toxic, post-conditioning and pre-conditioning. Intracerebroventricular injections of 0.9% normal saline (sham group) or LA were administered via microsyringe; in addition, a 20% lipid emulsion was injected into tail vein prior to the LA injection (pre-conditioning subgroups) or following rat respiratory arrest (post-conditioning subgroups)...
September 2015: Experimental and Therapeutic Medicine
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
Hisatake Matsumoto, Mitsuo Ohnishi, Ryosuke Takegawa, Tomoya Hirose, Yuji Hattori, Takeshi Shimazu
No specific treatment exists for poisoning with most fat-soluble drugs. Intravenous lipid emulsion (ILE) may be effective therapy against such drugs, but effects of ILE treatment are unclear. A 24-year-old woman with depression seen sleeping in the morning was found comatose in the evening, and an emerging lifesaving technologies service was called. After emerging lifesaving technologies departure to hospital, she stopped breathing, became pulseless, and cardiopulmonary life support was started immediately...
October 2015: American Journal of Emergency Medicine
Ludovic Gérard, Anne-Cécile Galloy, Arnaud Capron, Philippe Hantson
CASE REPORT: We describe the case of a 58-year-old woman who developed a severe distributive shock following the intentional ingestion of a large overdose of amlodipine (480 mg) combined with valsartan (3680 mg). Extreme vasoplegia remained refractory to maximal standard therapy including fluid resuscitation, intravenous calcium, vasopressors at very high doses, hyperinsulinemia-euglycemia therapy, lipid emulsion, and methylene blue administration. Besides, the patient exhibited hyperglycemia refractory to very high doses of insulin...
July 2015: Clinical Toxicology
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