Injection précoce d’émulsion lipidique et toxicité systémique débutante liée à un anesthésique local

Benhamou, Dan; Mazoit, Jean‐Xavier; Zetlaoui, Paul

doi:10.1016/j.annfar.2010.08.003

Cited by 13 publications

(2 citation statements)

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“…A rapid recovery occurred after 20% lipid emulsion administration. [5][6][7] In the second case, Benhamou et al 8 reported LAST occurring a few minutes after injection of 225 mg ropivacaine for a bilateral TAP block which was reversed in 2 minutes after 100 mL of 20% lipid emulsion administration. The rapid onset of toxicity was related to technical difficulties leading to direct IM local anesthetic injections.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Arrest from Local Anesthetic Toxicity After a Field Block and Transversus Abdominis Plane Block

et al. 2013

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We report the case of a 25-year-old female scheduled for laparoscopic gynecologic surgery under general anesthesia. At the end of laparoscopy, an intraperitoneal infiltration (ropivacaine 0.75%, 20 mL) was administered by the surgeon without informing the anesthesiologist. After tracheal extubation due to significant postoperative pain, the anesthesiologist performed a bilateral transversus abdominis plane block (ropivacaine 0.75%, 40 mL). A seizure followed by ventricular arrhythmia developed 10 minutes after local anesthetic injection. An infusion of 20% lipid emulsion was successful in converting the ventricular arrhythmia to a sinus rhythm. This overdose could have been avoided with better communication between anesthesiologist and surgeon.

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Section: Discussionmentioning

confidence: 99%

Cardiac Arrest from Local Anesthetic Toxicity After a Field Block and Transversus Abdominis Plane Block

et al. 2013

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“…Drug-drug interactions between ILE, concomitant therapies, and the ingested toxicant represent a potential issue [56,94]. Finally, there is no consensus on whether it is useful to administer ILE as early as the prodromal signs of acute intoxication occur, including in the case of LAST [95].…”

Section: Practical Considerationsmentioning

confidence: 99%

Lipid Emulsion to Treat Acute Poisonings: Mechanisms of Action, Indications, and Controversies

2023

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Biodetoxification using intravenous lipid emulsion (ILE) in acute poisoning is of growing interest. As well as for local anesthetics, ILE is currently used to reverse toxicity caused by a broad-spectrum of lipophilic drugs. Both pharmacokinetic and pharmacodynamic mechanisms have been postulated to explain its possible benefits, mainly combining a scavenging effect called “lipid sink” and cardiotonic activity. Additional mechanisms based on ILE-attributed vasoactive and cytoprotective properties are still under investigation. Here, we present a narrative review on lipid resuscitation, focusing on the recent literature with advances in understanding ILE-attributed mechanisms of action and evaluating the evidence supporting ILE administration that enabled the international recommendations. Many practical aspects are still controversial, including the optimal dose, the optimal administration timing, and the optimal duration of infusion for clinical efficacy, as well as the threshold dose for adverse effects. Present evidence supports the use of ILE as first-line therapy to reverse local anesthetic-related systemic toxicity and as adjunct therapy in lipophilic non-local anesthetic drug overdoses refractory to well-established antidotes and supportive care. However, the level of evidence is low to very low, as for most other commonly used antidotes. Our review presents the internationally accepted recommendations according to the clinical poisoning scenario and provides the precautions of use to optimize the expected efficacy of ILE and limit the inconveniences of its futile administration. Based on their absorptive properties, the next generation of scavenging agents is additionally presented. Although emerging research shows great potential, several challenges need to be overcome before parenteral detoxifying agents could be considered as an established treatment for severe poisonings.

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Lipid Rescue for Local Anesthetic and Nonlocal Anesthetic Drug Toxicity

Shiffman¹

2016

Liposuction

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Injection précoce d’émulsion lipidique et toxicité systémique débutante liée à un anesthésique local

Cited by 13 publications

References 2 publications

Cardiac Arrest from Local Anesthetic Toxicity After a Field Block and Transversus Abdominis Plane Block

Cardiac Arrest from Local Anesthetic Toxicity After a Field Block and Transversus Abdominis Plane Block

Lipid Emulsion to Treat Acute Poisonings: Mechanisms of Action, Indications, and Controversies

Lipid Rescue for Local Anesthetic and Nonlocal Anesthetic Drug Toxicity

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