Early Intralipid Therapy May Have Prevented Bupivacaine-Associated Cardiac Arrest

McCutchen, Thomas; Gerancher, J. C.

doi:10.1016/j.rapm.2007.09.006

Cited by 46 publications

(39 citation statements)

References 11 publications

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“…has been most frequently employed [3][4][5][6][7][8]. Subsequent lipid infusions, where instituted, have ranged from 0.2 ml.kg )1 .min )1 [3], to 400 ml infused 'freely' [15] reflecting a significant lack in uniformity in approach.…”

Section: Discussionmentioning

confidence: 99%

“…Infusion of lipid emulsion has been demonstrated to augment return of spontaneous circulation following poisoning with long acting local anaesthetic agents in animal models [1,2], and human cases [3][4][5][6][7][8]. Lipid dosing employed in experimental models of rescue from local anaesthetic and other lipophilic cardiotoxin overdose, however, varies widely [1,2,[9][10][11][12][13].…”

mentioning

confidence: 99%

“…Lipid dosing employed in experimental models of rescue from local anaesthetic and other lipophilic cardiotoxin overdose, however, varies widely [1,2,[9][10][11][12][13]. Similarly, published clinical reports of successful resuscitation from local anaesthetic induced cardiac arrest have employed dissimilar dosing application [3][4][5][6][7][8].…”

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confidence: 99%

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Evaluation of the Association of Anaesthetists of Great Britain and Ireland lipid infusion protocol in bupivacaine induced cardiac arrest in rabbits

2009

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SummaryInfusion of lipid emulsion has been demonstrated to facilitate return of spontaneous circulation in animal models and human cases of local anaesthetic induced cardiac arrest. Guidelines for lipid application exist; however, experimental evidence of efficacy at recommended dosing is lacking. In 20 sedated, mechanically ventilated, and invasively monitored New Zealand White rabbits, asystole was induced via bolus bupivacaine injection. Animals were randomised to receive either 20% Intralipid administered according to Association of Anaesthetists of Great Britain and Ireland guidelines, or identical volumes of 0.9% saline solution, in addition to standard Advanced Cardiac Life Support resuscitative measures. Seven lipid treated rabbits developed return of spontaneous circulation vs four saline treated animals (p = 0.370). A trend toward sooner return of spontaneous circulation in the lipid treated group was observed (2.4 (0.53) vs 3.8 (1.7) min; p = 0.082). Five animals in the lipid treated group survived to protocol termination vs nil animals from the saline treated group (p = 0.033). The current Association of Anaesthestists of Great Britain and Ireland lipid infusion protocol provides a useful beginning for lipid emulsion administration.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of the Association of Anaesthetists of Great Britain and Ireland lipid infusion protocol in bupivacaine induced cardiac arrest in rabbits

2009

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“…Because of the rarity and severity of local anaesthetic-induced cardiotoxicity, it is not possible or ethical to conduct human research on the underlying problem. 36 Human case reports 11,19,20,[37][38][39][40][41][42][43][44][45] describing successful lipid rescue are therefore invaluable. 26 When should lipid therapy be started?…”

Section: Reviewmentioning

confidence: 99%

Lipid rescue: the use of lipid emulsions to treat local anaesthetic toxicity

Kruger

Marwick

Levin

2009

Southern African Journal of Anaesthesia and Analgesia

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“…Additional animal studies, coupled with positive outcomes following ILE use in humans [2][3][4][5], have subsequently led to clinical recommendation for ILE use in local anesthetic overdose [6,7]. The success and safety of lipid resuscitation in this context, combined with a paucity of alternative antidotes, has seen ILE become firmly established as the antidote of choice for local anesthetic systemic toxicity (LAST).…”

Section: Introductionmentioning

confidence: 99%

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

et al. 2014

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The use of intravenous lipid emulsion (ILE) as an antidote has prompted significant academic and clinical interest. Between August 2009 and August 2012, data from cases of ILE use in intoxicated patients in different hospitals on different continents were voluntarily entered into a registry based on the world wide web (www.lipidregistry.org). Here, we report data from this project. Participating centers were given access to the registry following institutional subscription. Specifically sought were details of the individual patients' presenting condition, indications for ILE use, ILE administration regimen, potential complications, and of clinical outcome. Forty-eight uses of ILE were reported from 61 participating centers. Ten cases of local anesthetic systemic toxicity were reported; all (10/10) survived. Thirtyeight cases of intoxication by other agents were reported [30 decreased conscious state, 8 cardiovascular collapse (3 deaths)]. There was an elevation in GCS (p<0.0001) and increased systolic blood pressure (p=0.012) from immediately prior to ILE administration to 30 min after use. One serious and two minor adverse effects of ILE use were recorded in 48 reported cases (one case of bronchospastic reaction, one case of hyperamylasemia and one case of interference with laboratory testing). In this series of cases reported to the registry, improvements were seen for GCS in patients with central nervous system toxicity and in systolic blood pressure in shocked patients over a short time frame after the injection of ILE. Few adverse effects were recorded. Clinical trials and the reporting of drug concentrations after ILE use are necessary to further elucidate the role of ILE in clinical toxicology.

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Early Intralipid Therapy May Have Prevented Bupivacaine-Associated Cardiac Arrest

Abstract: Early treatment with Intralipid may help prevent cardiac arrest and speed successful resuscitation efforts.

Cited by 46 publications

References 11 publications

Evaluation of the Association of Anaesthetists of Great Britain and Ireland lipid infusion protocol in bupivacaine induced cardiac arrest in rabbits

Evaluation of the Association of Anaesthetists of Great Britain and Ireland lipid infusion protocol in bupivacaine induced cardiac arrest in rabbits

Lipid rescue: the use of lipid emulsions to treat local anaesthetic toxicity

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

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