Comparison of epinephrine vs lipid rescue to treat severe local anesthetic toxicity – an experimental study in piglets

Mauch, Jacqueline; Jurado, Olga Martin; Spielmann, Nelly; Bettschart‐Wolfensberger, Regula; Weiß, Markus

doi:10.1111/j.1460-9592.2011.03652.x

Cited by 26 publications

(16 citation statements)

References 25 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Normalization of hemodynamic parameters (HR, MAP) and ET(CO2) was fastest in group 1 with all piglets achieving HR and MAP values. Hemodynamic compromise owing to bupivacaine intoxication in piglets, first-line rescue with epinephrine was more effective than Intralipid with regard to survival as well as normalization of hemodynamic parameters and ET(CO2) [10].…”

Section: The Lipid Sink Effectmentioning

confidence: 91%

Intralipid treatment: Is it only the tip of an iceberg? A new suggestion: Bone cement implantation syndrome (BCIS)

Eldor¹,

Kotlovker²

2012

J Anesthesiol Clin Sci

View full text Add to dashboard Cite

On 1998 it was first showed that intravenous intralipid could prevent or improve resuscitation from cardiovascular collapse by severe bupivacaine overdose in rats. Since then published examples now include toxicities related to verapamil, diltiazem, amlodipine, quetiapine and sertraline, haldoperidol, lamotrigine, olanzapine, propranolol, atenolol, nevibolol, doxepin, dosulepin, imipramine, amitriptyline, glyosphate herbicide, flecainide, venlafaxine, moxidectin, and others. Intralipid treatment is a new treatment for Bone cement implantation syndrome (BCIS) which was never suggested before. Animal studies should be done in order to evaluate this new treatment modality.

show abstract

Section: The Lipid Sink Effectmentioning

confidence: 91%

Intralipid treatment: Is it only the tip of an iceberg? A new suggestion: Bone cement implantation syndrome (BCIS)

Eldor¹,

Kotlovker²

2012

J Anesthesiol Clin Sci

View full text Add to dashboard Cite

show abstract

“…Normalization of hemodynamic parameters (HR, MAP) and ET(CO 2 ) was fastest in group 1 with all piglets achieving HR and MAP values. hemodynamic compromise owing to bupivacaine intoxication in piglets, first-line rescue with epinephrine was more effective than Intralipid with regard to survival as well as normalization of hemodynamic parameters and ET(CO 2 ) [15]. Intravenous lipid emulsion (ILE) has been proposed as a rescue therapy for severe local anesthetic drugs toxicity, but experience is limited with other lipophilic drugs.…”

Section: The Intralipid Sink Effectmentioning

confidence: 99%

Can intralipid infusion open a coronary occlusion causing acute myocardial infarction?

Eldor¹

2017

Clin Med Invest

View full text Add to dashboard Cite

Coronary heart disease remains the leading cause of morbidity and mortality in Western countries. The best hope of salvaging viable myocardium after a coronary occlusion is by rapid reperfusion of the ischemic myocardium, either by thrombolysis or primary percutaneous coronary intervention. The use of intravenous intralipid infusion instead of thrombolysis or primary percutaneous coronary intervention is first suggested in the medical literature.Correspondence to: Joseph Eldor, Theoretical Medicine Institute, Jerusalem, Israel, E-mail: csen_international@csen.com Key words: intralipid, myocardial infarction, coronary occlusionReceived: June 18, 2017; Accepted: July 15, 2017; Published: July 17, 2017 Thrombolysis or primary percutaneous coronary intervention or Intralipid Infusion?Coronary heart disease remains the leading cause of morbidity and mortality in Western countries. The best hope of salvaging viable myocardium after a coronary occlusion is by rapid reperfusion of the ischemic myocardium, either by thrombolysis or primary percutaneous coronary intervention. Although reperfusion restores blood flow, oxygen, and nutrients to the cardiac muscle, it also has the potential to induce reperfusion injury.Postconditioning of the heart with brief episodes of reperfusion/ occlusion at the onset of reflow has been shown to limit infarct size. However, this approach is not practical for patients treated with thrombolytic agents and therefore a more generic pharmacologic postconditioning is still needed. The ideal pharmacologic candidates need to be safe and effective when administered during the first few minutes of reperfusion by inducing cellular protection or enhancing myocardial tolerance to ischemia/reperfusion injury. Several drugs have yielded encouraging results in animals and a few have been tested in humans; however, none of these modalities has been widely accepted.Lipids and in particular polyunsaturated fatty acids have received special cardiovascular research attention because polyunsaturated fatty acid-rich diets are associated with a decreased risk of coronary artery disease. Acute application of polyunsaturated fatty acids to cardiomyocytes has also been shown to shorten action potential duration and this could account for the antiarrhythmic mechanism of the polyunsaturated fatty acids. Intralipid (Sigma, St. Louis, MO) is a brand name for the first safe fat emulsion for human use; Intralipid 20% is an emulsion of soybean oil (20%), egg yolk phospholipids (1.2%), and glycerol (2.2%). Intralipid has been widely used in patients who need total parenteral nutrition and as a vehicle for different drugs such as propofol. It has been shown recently that postischemic administration of Intralipid protects the isolated rat heart against ischemia/reperfusion injury. However, the molecular mechanism in which Intralipid mediates cardioprotection is completely unknown [1].Intralipid, a brand name for the first safe fat emulsion for human use, has been shown to be cardioprotective. However, the mechanism ...

show abstract

“…Vereinzelt wurde Intralipid® sogar als Erstlinientherapie bei systemischer Intoxikation vorgeschlagen [36,40]. Untersuchungen an Babyschweinen belegten jedoch, dass sowohl bei schwerer Herz-Kreislauf-Depression infolge LA-Intoxikation als auch beim Herz-Kreislauf-Stillstand Adrenalin als Erstlinientherapie deutlich effektiver ist als Intralipid® und somit unverzichtbar bleibt [27,28]. Entsprechend muss bei einer LA-Intoxikation mit Herz-Kreislauf-Depression oder -kollaps weiterhin primär nach den klassischen Algorithmen reanimiert und Intralipid® in zweiter Linie eingesetzt werden.…”

Section: Therapieunclassified

Kaudalanästhesie bei Kindern

Mauch

Weiß

2012

Anaesthesist

View full text Add to dashboard Cite

Caudal block is a safe procedure commonly used for pediatric perioperative analgesia. Complications are extremely rare but nevertheless local and systemic contraindications must be excluded. Optimal safety and quality result when strict attention is paid to technical details. These are discussed in detail in this review. A local anesthetic (LA) containing epinephrine allows early detection of inadvertent intravascular LA administration; therefore an epinephrine/LA mixture is recommended at least for the test dose. In terms of safety the choice of LA itself is probably of secondary importance. Clonidine as an adjuvant has an excellent risk/benefit profile with minimal side effects. Inadvertent systemic LA intoxication is a rare but potentially fatal complication of regional anesthesia and measures for prevention and early detection are essential. Should circulatory arrest occur, immediate resuscitation following standard guidelines is to be initiated including the use of epinephrine as the first line drug. Intravenous administration of lipid solutions may be beneficial as a secondary adjunct to stabilize hemodynamics but is not an alternative to epinephrine.

show abstract

Comparison of epinephrine vs lipid rescue to treat severe local anesthetic toxicity – an experimental study in piglets

Abstract: For the treatment of severe hemodynamic compromise owing to bupivacaine intoxication in piglets, first-line rescue with epinephrine was more effective than Intralipid with regard to survival as well as normalization of hemodynamic parameters and ET(CO2) .

Cited by 26 publications

References 25 publications

Intralipid treatment: Is it only the tip of an iceberg? A new suggestion: Bone cement implantation syndrome (BCIS)

Intralipid treatment: Is it only the tip of an iceberg? A new suggestion: Bone cement implantation syndrome (BCIS)

Can intralipid infusion open a coronary occlusion causing acute myocardial infarction?

Kaudalanästhesie bei Kindern

Contact Info

Product

Resources

About