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You are here: Home / 14. Toxicology / Local Anesthetics Toxicity and Intralipids

Local Anesthetics Toxicity and Intralipids

July 14, 2011 by CrashMaster

Local Anesthetics

Recent recs from the anesthesia world

Intralipids

lipidrescue.com

Data from humans are limited to two case reports (see News) and no prospective epidemiologic study is possible since numbers are too small; and ethical considerations rule out experiments on volunteers. So these data are very limited as well. Both patients received bolus injections of 100 mL 20% Intralipid followed by continuous infusions at either 0.5 mL/kg/min for 2 hours, or 10 mL/min for 10 minutes. In both cases, the same general approach was used as in the animal experiments, namely a bolus followed by a continuous infusion.

Given an understanding of these limitations in our method an Example Protocol follows; this should be used only after standard resuscitation methods fail to re-establish sufficient circulatory stability:

20% Intralipid:

1.5 mL/kg as an initial bolus, followed by

0.25 mL/kg/min for 30-60 minutes

Bolus could be repeated 1-2 times for persistent asystole

Infusion rate could be increased if the BP declines.

See the Instructions link in the Navigator to find sample protocols for LipidRescue as Word files that you can print and laminate . These could then be attached to lipid emulsion bags stored for this purpose near your block rooms.

 

Intralipid

® for Overdoses

Intralipid

® (lipid emulsion) is intravenous fat emulsion used to supplement parenteral nutrition, but has been

studied as a possible salvaging therapy for certain overdoses. Intralipid

® is composed of triglycerides, phospholipids

and choline. Intralipid

® forms chylomicron-like droplets in the serum that may act as a “sink” for

lipid soluble toxins. The toxins distribute into the chylomicrons, away from binding sites and target organs of

toxicity. Intralipid

® may also modulate cardiac energy and improve calcium channel functioning, but these

effects are felt to be minor.

Intralipid

® use has been studied in animal models of bupivicaine, verapamil, clomipramine and propranolol

cardiotoxicity. Human case reports of successful use of Intralipid

® for bupivacaine, ropivacaine and bupropion–

induced cardiac arrest are published. It is important to remember that current human data are limited

on this experience. At this point, Intralipid

® is only indicated if the patient suffers from a cardiac arrest

from an exposure to the following:

Intralipid

® 20% is given as an intravenous bolus in a dose of 1.5 mL/kg over 1 min. The bolus may be repeated

one time if the patient remains in cardiac arrest. This is followed by 15 mL/kg/hr over 30-60 minutes.

Intralipid

® can also be administered peripherally. Potential complications with Intralipid® are fat embolization,

interactions with other medications (such as vasopressors) leading to decreased efficacy, and

allergic reactions (egg-derived). (Maryland Tox Center)

 

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Filed Under: 14. Toxicology


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