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Lipid emulsion resuscitation

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https://www.readbyqxmd.com/read/28692439/lipid-emulsion-in-local-anesthetic-toxicity
#1
Martyn Harvey, Grant Cave
PURPOSE OF REVIEW: Enthusiasm for regional anesthesia has been driven by multimodal benefits to patient outcomes. Despite widespread awareness and improved techniques (including the increasing use of ultrasound guidance for block placement), intravascular sequestration and the attendant risk of local anesthetic systemic toxicity (LAST) remains. Intravenous lipid emulsion (ILE) for the treatment of LAST has been endorsed by anesthetic regulatory societies on the basis of animal study and human case report data...
July 7, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28652958/lidocaine-induced-systemic-toxicity-a-case-report-and-review-of-literature
#2
Badar Hasan, Talal Asif, Maryam Hasan
For the past 50 years, local anesthetics such as lidocaine have been commonly used in various clinical settings. Its use is not just limited to anesthesia and surgery but is also frequently utilized in internal medicine and in primary care setting for bedside procedures. Despite its widespread use, most physicians are not familiar with the life-threatening manifestations of lidocaine toxicity and its treatment. Our case demonstrates a successful resuscitation after cardiac arrest in a healthy 33-year-old female with systemic lidocaine toxicity after she received lidocaine as a local anesthetic...
May 25, 2017: Curēus
https://www.readbyqxmd.com/read/28644688/intraosseous-administration-of-antidotes-a-systematic-review
#3
Audrée Elliott, Pierre-André Dubé, Amélie Cossette-Côté, Laura Patakfalvi, Eric Villeneuve, Martin Morris, Sophie Gosselin
CONTEXT: Intraosseous (IO) access is an established route of administration in resuscitation situations. Patients with serious poisoning presenting to the emergency department may require urgent antidote therapy. However, intravenous (IV) access is not always readily available. OBJECTIVE: This study reviews the current evidence for IO administration of antidotes that could be used in poisoning. The primary outcome was mortality as a surrogate of efficacy. Secondary outcomes included hemodynamic variables, electrocardiographic variables, neurological status, pharmacokinetics outcomes, and adverse effects as defined by each article...
June 23, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28562387/lipid-resuscitation-in-acute-poisoning-after-a-decade-of-publications-what-have-we-really-learned
#4
Lotte C G Hoegberg, Sophie Gosselin
PURPOSE OF REVIEW: The decision to provide intravenous lipid emulsion (ILE) therapy as a treatment modality for the reversal of various drug toxicity was discovered in the last decade. Numerous publications, in both humans and animals attest to its clinical use, but current supporting evidence is inconsistent. RECENT FINDINGS: A recent systematic review reported evidence for benefit of ILE in bupivacaine toxicity. Human randomized trials, large observational studies as well as animal models of orogastric poisoning failed to report a clear benefit of ILE for nonlocal anesthetics poisoning...
August 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28514346/-systemic-toxicity-of-local-anesthetics
#5
S A Rabinovich, L A Zavodilenko
The paper presents characteristics of local anesthetics used in dentistry and maxillofacial surgery taking into account their effectiveness and toxicity. We described the main clinical symptoms of manifestation of systemic toxicity and measures for prevention of local anesthesia complications, as well as the detailed protocol of 'lipid rescue' and resuscitation at manifestation of systemic toxic reaction of local anesthetics with the mechanism of the fatty emulsion action.
2017: Stomatologii︠a︡
https://www.readbyqxmd.com/read/28502090/successful-use-of-lipid-emulsion-to-resuscitate-a-foal-after-intravenous-lidocaine-induced-cardiovascular-collapse
#6
V Vieitez, I Á Gómez de Segura, M Martin-Cuervo, L Alfonso Gracia, L Javier Ezquerra
BACKGROUND: Lipid emulsion has been reported to be effective for the treatment of local anaesthetic overdoses in rats, dogs and humans. OBJECTIVES: To describe the successful treatment of cardiovascular lidocaine toxicity in a foal with intravenous lipid administration. STUDY DESIGN: Observational study: case report. METHODS: An 8-month-old Arabian cross foal was anaesthetised for removal of the right alar fold and nasal plate...
May 14, 2017: Equine Veterinary Journal
https://www.readbyqxmd.com/read/28346007/lipid-emulsion-improves-survival-in-animal-models-of-local-anesthetic-toxicity-a-meta-analysis
#7
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
https://www.readbyqxmd.com/read/28254832/dramatic-resuscitation-with-intralipid-in-an-epinephrine-unresponsive-cardiac-arrest-following-overdose-of-amitriptyline-and-propranolol
#8
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
https://www.readbyqxmd.com/read/28165812/the-protective-effect-of-lipid-emulsion-in-preventing-bupivacaine-induced-mitochondrial-injury-and-apoptosis-of-h9c2-cardiomyocytes
#9
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
https://www.readbyqxmd.com/read/28032304/l-carnitine-reduces-susceptibility-to-bupivacaine-induced-cardiotoxicity-an-experimental-study-in-rats
#10
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
https://www.readbyqxmd.com/read/27872765/cardiac-arrest-after-local-anaesthetic-toxicity-in-a-paediatric-patient
#11
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
https://www.readbyqxmd.com/read/27281728/giving-priority-to-lipid-administration-can-reduce-lung-injury-caused-by-epinephrine-in-bupivacaine-induced-cardiac-depression
#12
COMPARATIVE STUDY
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
https://www.readbyqxmd.com/read/27272169/intralipid-in-acute-caffeine-intoxication-a-case-report
#13
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/27142757/intravenous-lipid-emulsion-in-the-resuscitation-of-cocaine-induced-cardiovascular-arrest-in-a-rat-model
#14
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
https://www.readbyqxmd.com/read/27136657/comparison-of-resuscitative-protocols-for-bupropion-overdose-using-lipid-emulsion-in-a-swine-model
#15
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
https://www.readbyqxmd.com/read/27068728/serum-alkalinisation-is-the-cornerstone-of-treatment-for-amitriptyline-poisoning
#16
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
https://www.readbyqxmd.com/read/27046186/comparative-resuscitative-methods-for-venlafaxine-toxicity-in-a-swine-model
#17
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
https://www.readbyqxmd.com/read/27043033/local-anesthetic-toxicity-who-is-ready-for-lipid-resuscitation-a-survey-of-german-hospitals
#18
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
https://www.readbyqxmd.com/read/26964391/failure-of-intravenous-lipid-emulsion-in-treatment-of-cardiotoxicity-caused-by-mixed-overdose-including-dihydropyridine-calcium-channel-blockers
#19
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
https://www.readbyqxmd.com/read/26951350/practical-recommendations-for-calcium-channel-antagonist-poisoning
#20
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
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