Efficacité d’une émulsion de Medialipide® pour reverser les signes neurologiques de toxicité systémique des anesthésiques locaux

Diaz, James H.; Bernasinski, Michaël; Malinovsky, J.-M.

doi:10.1016/j.annfar.2012.05.001

Cited by 11 publications

(5 citation statements)

References 10 publications

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“…Intralipid is mainly used to treat local anaesthetic systemic toxicity, and Lipofundin MCT/LCT is sometimes used to treat local anaesthetic systemic toxicity [19][20][21][22][23][24]. Although lipid emulsion alleviates the toxic dose of bupivacaine-mediated inhibition of vasodilation induced by the K ATP channel agonist levcromakalim primarily by scavenging effects regarded as indirect action, Intralipid may provide a more favourable effect than Lipofundin MCT/LCT on the maintenance of vasodilation induced by K ATP channel activation mediated through the pathophysiological state caused by local anaesthetic systemic toxicity [25].…”

Section: Discussionmentioning

confidence: 99%

Lipofundin MCT/LCT Inhibits Levcromakalim-Induced Vasodilation by Inhibiting Endothelial Nitric Oxide Release

Lee

Kang

et al. 2020

IJMS

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The goal of this study was to examine the effect of lipid emulsion on the vasodilation induced by ATP-sensitive potassium (KATP) channels in isolated rat aortae and the underlying mechanism. The effects of Intralipid, containing 100% long-chain fatty acids, and Lipofundin MCT/LCT, containing 50% long-chain fatty acids plus 50% medium-chain fatty acids, on the vasodilation induced by levcromakalim in endothelium-intact aorta with or without NW-nitro-L-arginine methyl ester (L-NAME) and in endothelium-denuded aorta were examined. The effects of L-arginine, L-NAME, glibenclamide, and Lipofundin MCT/LCT, alone or combined, on the levcromakalim-induced vasodilation were examined. Lipofundin MCT/LCT inhibited the levcromakalim-induced vasodilation of isolated endothelium-intact aortae, whereas Intralipid did not. In addition, Lipofundin MCT/LCT had no effect on the levcromakalim-induced vasodilation of endothelium-denuded rat aortae and endothelium-intact aortae with L-NAME. L-arginine and Lipofundin MCT/LCT produced more levcromakalim-induced vasodilation than Lipofundin MCT/LCT alone. Glibenclamide inhibited levcromakalim-induced vasodilation. Levcromakalim did not significantly alter endothelial nitric oxide synthase phosphorylation, whereas Lipofundin MCT/LCT decreased cyclic guanosine monophosphate. Lipofundin MCT/LCT did not significantly alter levcromakalim-induced membrane hyperpolarization. Taken together, these results suggest that Lipofundin MCT/LCT inhibits the vasodilation induced by levcromakalim by inhibiting basally released endothelial nitric oxide, which seems to occur through medium-chain fatty acids.

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Section: Discussionmentioning

confidence: 99%

Lipofundin MCT/LCT Inhibits Levcromakalim-Induced Vasodilation by Inhibiting Endothelial Nitric Oxide Release

Lee

Kang

et al. 2020

IJMS

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“…18 Another case details a term parturient who developed progressive hypotension, nausea, drowsiness, tremors, nystagmus, and loss of consciousness five minutes after receiving an epidural analgesia mixture of levobupivacaine, sufentanil, and clonidine. 19 Lastly, a severe case recounts a 39-year-old parturient who received ropivacaine for epidural anesthesia and subsequently suffered a seizure, chest pain, pulseless ventricular tachycardia, and cardiac arrest within 22 minutes. 14…”

Section: Discussionmentioning

confidence: 99%

Local Anesthetic Systemic Toxicity in Pregnancy: A Retrospective Cohort Analysis

de Valle,

Adkison,

Stevenson

et al. 2024

Preprint

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Introduction Local Anesthetic Systemic Toxicity (LAST) is a rare complication of regional anesthesia. Pregnancy is a risk factor due to gestational physiologic changes. Labor and disorders of pregnancy can mask or delay symptoms of LAST, slowing appropriate intervention. This study examines LAST within a larger cohort and identifies features that help distinguish LAST in pregnancy from nonpregnant patients. Methods The TriNetX database was used to compare pregnant and nonpregnant patients with LAST from 2013 to 2023. Cohorts were matched on age, race, obesity status, diabetes, metabolic disorders, local anesthetic type, and cardiovascular, liver, kidney, and respiratory disease. Outcomes included prodromal symptoms of LAST and symptoms of cardiac and central nervous system excitation and depression. Results Matching occurred for 276 pregnant and 276 nonpregnant patients. Pregnant cohorts had a significantly higher risk of cardiac depression (RR, 1.96 [95% CI 1.44 - 2.66], p<0.01) and significantly lower risk of cardiac excitation (RR, 0.38 [95% CI 0.22-0.63], p<0.01), prodromal symptoms (RR, 0.17 [95% CI 0.09 - 0.33], p<0.01), central nervous system excitation (RR, 0.44 [95% CI 0.21-0.90], p=0.02), and central nervous system depression (RR, 0.24 [95% CI 0.13-0.48], p<0.01) than nonpregnant cohorts. Conclusion Pregnant patients with LAST were more likely to exhibit cardiac depression and less likely to manifest prodromal symptoms, cardiac excitation, and central nervous system excitation and depression than nonpregnant patients. Physiological changes during pregnancy and prompt detection and treatment may explain these differences. These findings highlight the variable nature of LAST and how pregnancy may influence its clinical presentation.

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“…The mechanism of action of ILE appears to be essentially related to the binding property of the emulsion. Different ILEs have been used, such as the one administered to our patient [ 61 ], and this strategy has also been successfully applied to the paediatric population [ 62 ]. Regional anaesthesia is used in about one third of all surgical procedures in neonates and has proven useful in improving the treatment of postoperative pain and reducing the use of systemic analgesics such as opioids [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

Fatal accidental lipid overdose with intravenous composite lipid emulsion in a premature newborn: a case report

et al. 2021

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Background Tenfold or more overdose of a drug or preparation is a dreadful adverse event in neonatology, often due to an error in programming the infusion pump flow rate. Lipid overdose is exceptional in this context and has never been reported during the administration of a composite intravenous lipid emulsion (ILE). Case presentation Twenty-four hours after birth, a 30 weeks’ gestation infant with a birthweight of 930 g inadvertently received 28 ml of a composite ILE over 4 h. The ILE contained 50% medium-chain triglycerides and 50% soybean oil, corresponding to 6 g/kg of lipids (25 mg/kg/min). The patient developed acute respiratory distress with echocardiographic markers of pulmonary hypertension and was treated with inhaled nitric oxide and high-frequency oscillatory ventilation. Serum triglyceride level peaked at 51.4 g/L, 17 h after the lipid overload. Triple-volume exchange transfusion was performed twice, decreasing the triglyceride concentration to < 10 g/L. The infant’s condition remained critical, with persistent bleeding and shock despite supportive treatment and peritoneal dialysis. Death occurred 69 h after the overdose in a context of refractory lactic acidosis. Conclusions Massive ILE overdose is life-threatening in the early neonatal period, particularly in premature and hypotrophic infants. This case highlights the vigilance required when ILEs are administered separately from other parenteral intakes. Exchange transfusion should be considered at the first signs of clinical or biological worsening to avoid progression to multiple organ failure.

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Efficacité d’une émulsion de Medialipide® pour reverser les signes neurologiques de toxicité systémique des anesthésiques locaux

Cited by 11 publications

References 10 publications

Lipofundin MCT/LCT Inhibits Levcromakalim-Induced Vasodilation by Inhibiting Endothelial Nitric Oxide Release

Lipofundin MCT/LCT Inhibits Levcromakalim-Induced Vasodilation by Inhibiting Endothelial Nitric Oxide Release

Local Anesthetic Systemic Toxicity in Pregnancy: A Retrospective Cohort Analysis

Fatal accidental lipid overdose with intravenous composite lipid emulsion in a premature newborn: a case report

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