{"id":5370,"date":"2011-07-14T20:25:53","date_gmt":"2011-07-14T20:25:53","guid":{"rendered":"http:\/\/crashtext.org\/misc\/local-anesthetics.htm\/"},"modified":"2012-07-25T19:08:40","modified_gmt":"2012-07-25T23:08:40","slug":"local-anesthetics","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/toxicology\/local-anesthetics.htm\/","title":{"rendered":"Local Anesthetics Toxicity and Intralipids"},"content":{"rendered":"

<\/span>Local Anesthetics<\/span><\/h2>\n

Recent recs from the anesthesia world<\/a><\/p>\n

<\/span>Intralipids<\/span><\/h3>\n

lipidrescue.com<\/p>\n

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.<\/p>\n

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:<\/p>\n

20% Intralipid:<\/strong><\/p>\n

1.5 mL\/kg as an initial bolus, followed by<\/strong><\/p>\n

0.25 mL\/kg\/min for 30-60 minutes<\/strong><\/p>\n

Bolus could be repeated<\/strong> 1-2 times for persistent asystole<\/p>\n

Infusion rate could be increased<\/strong> if the BP declines.<\/p>\n

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\u00a0to lipid emulsion bags stored for this purpose near your block rooms.<\/p>\n

 <\/p>\n

Intralipid<\/strong><\/p>\n

\u00ae for Overdoses<\/strong><\/p>\n

Intralipid<\/p>\n

\u00ae (lipid emulsion) is intravenous fat emulsion used to supplement parenteral nutrition, but has been<\/p>\n

studied as a possible salvaging therapy for certain overdoses. Intralipid<\/p>\n

\u00ae is composed of triglycerides, phospholipids<\/p>\n

and choline. Intralipid<\/p>\n

\u00ae forms chylomicron-like droplets in the serum that may act as a \u0093sink\u0094 for<\/p>\n

lipid soluble toxins. The toxins distribute into the chylomicrons, away from binding sites and target organs of<\/p>\n

toxicity. Intralipid<\/p>\n

\u00ae may also modulate cardiac energy and improve calcium channel functioning, but these<\/p>\n

effects are felt to be minor.<\/p>\n

Intralipid<\/p>\n

\u00ae use has been studied in animal models of bupivicaine, verapamil, clomipramine and propranolol<\/p>\n

cardiotoxicity. Human case reports of successful use of Intralipid<\/p>\n

\u00ae for bupivacaine, ropivacaine and bupropion\u0096<\/p>\n

induced cardiac arrest are published. It is important to remember that current human data are limited<\/p>\n

on this experience. At this point, Intralipid<\/p>\n

\u00ae is only indicated if the patient suffers from a cardiac arrest<\/p>\n

from an exposure to the following:<\/p>\n

Intralipid<\/p>\n

\u00ae 20% is given as an intravenous bolus in a dose of 1.5 mL\/kg over 1 min. The bolus may be repeated<\/p>\n

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

Intralipid<\/p>\n

\u00ae can also be administered peripherally. Potential complications with Intralipid\u00ae are fat embolization,<\/p>\n

interactions with other medications (such as vasopressors) leading to decreased efficacy, and<\/p>\n

allergic reactions (egg-derived). (Maryland Tox Center)<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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