Intravenous fat emulsion: A potential novel antidote

Turner-Lawrence, Danielle; Kerns, William

doi:10.1007/bf03160965

Cited by 71 publications

(71 citation statements)

References 44 publications

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“…Turner-Laurence and Kerns demonstrated in vitro the binding capacity of lipid emulsions to local anesthetics in buffer solutions 19 .…”

Section: Discussionmentioning

confidence: 99%

“…This alteration was described as one of the side effects of LE when a dose higher than 100 mg.kg -1 .h was used or when LE was given to patients with previous pulmonary disease 27 . Finally, other side effects of lipid emulsions have been described: risk of infection, allergic reactions especially in soy oil emulsions, thrombophlebitis, increased amylase, hyperlipidemia, hemolytic anemia, thrombocytopenia and fat embolus 19 .…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

et al. 2012

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PURPOSE:To evaluate the hemodynamic changes following SMOFlipid emulsion therapy with after bupivacaine intoxication in swines. METHODS: Large White pigs were anesthetized with thiopental, tracheal intubation was performed and mechanical ventilation was instituted. Hemodynamic variables were recorded with invasive pressure monitoring and pulmonary artery catheterization (Swan-Ganz catheter). After a 30-minute resting period, 5 mg.kg -1 of bupivacaine by intravenous injection was administered and new hemodynamic measures were performed 1 minute later; the animals were than randomly divided into two groups and received 4 ml.kg -1 of saline solution or 4 ml.kg -1 of SMOFlipid emulsion 20%. Hemodynamic changes were then re-evaluated at 5, 10, 15, 20 and 30 minutes. RESULTS: Bupivacaine intoxication caused fall in arterial blood pressure, cardiac index, ventricular systolic work index mainly and no important changes in vascular resistances. SMOFlipid emulsion therapy was able to improve blood pressure mainly by increasing vascular resistance since the cardiac index had no significant improvement in our study. Hemodynamic results of the use of lipid emulsion in bupivacaine intoxication were better than the control group. CONCLUSION: The SMOFlipid emulsion is a option for reversing hypotension in cases of intoxication by bupivacaine. Key words: Anesthesia, Local. Bupivacaine. Lipids. Hemodynamics. Fat Emulsions, Intravenous. Swine. RESUMO OBJETIVO:Avaliar as alterações hemodinâmicas da terapia lipídica com SMOFlipid após intoxicação com bupivacaína em suínos. MÉTODOS: Suínos da raça Large White foram anestesiados com tiopental, realizada intubação traqueal e mantidos em ventilação mecânica. As variáveis hemodinâmicas foram registradas através de pressão invasiva e cateterização da artéria pulmonar (cateter de Swan-Ganz). Após período de 30 minutos de repouso, 5 mg.kg -1 de bupivacaína foram injetados por via endovenosa e novas medidas hemodinâmicas foram realizadas 1 minuto após; os animais foram então aleatoriamente divididos em dois grupos e receberam 4 ml.kg -1 de solução salina ou 4 ml.kg -1 da emulsão tipo SMOFlipid a 20%. As alterações hemodinâmicas foram reavaliadas aos 5, 10, 15, 20 e 30 minutos. RESULTADOS: A intoxicação pela bupivacaína causou queda da pressão arterial, índice cardíaco e do trabalho sistólico dos ventrículos principalmente sem importantes alterações das resistências vasculares. A terapia com a emulsão SMOFlipid foi capaz de melhorar a pressão arterial através, principalmente, do aumento das resistências vasculares uma vez que o índice cardíaco não apresentou melhora expressiva em nosso estudo. Os resultados hemodinâmicos com o uso da emulsão lipídica na intoxicação pela bupivacaína foram melhores que no grupo controle. CONCLUSÃO: A emulsão SMOFlipid é uma opção para reverter a hipotensão em caso de intoxicação pela bupivacaína.

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“…Turner-Laurence and Kerns demonstrated in vitro the binding capacity of lipid emulsions to local anesthetics in buffer solutions 19 .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

et al. 2012

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“…Two recent publications have summarized individual cases reported in the literature [25,26]. Case report data can be instructional in offering insights into therapies, and are particularly useful when outlining an "all or nothing" type clinical situation.…”

Section: Case Reportsmentioning

confidence: 99%

Lipid Emulsion Infusion in Resuscitation for Local Anesthetic and Other Drug Overdose

Chaparoska¹,

Baneva²

2014

Macedonian Medical Review

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The use of intravenous lipid emulsions (ILEs) as antidote in local anesthetic systemic toxicity has gained widespread support following convincing data from animal models, and successful case reports in humans. Аn injection of a simple, intravenous nutritional solution could be acutely life-saving for a patient with severe drug overdose. But dozens of published case reports support this observation, the first ones made more than a decade ago in a rodent model of bupivacaine toxicity. It is even more surprising that such a simple formulation can rapidly reverse severe clinical toxicity from a variety of vastly disparate medications with distinct pharmacodynamics and mechanisms of action. This review will focus on the clinical application of lipid emulsion therapy in resuscitation from drug-related toxicity and will provide an introduction to the development of a method, guidelines for its use, and insights into potential controversies and future applications [1].

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“…Since its introduction in 1961, intravenous lipid emulsion (ILE) has evolved from a component of total parenteral nutrition, to a drug delivery vehicle, to its most recent role as an adjunct in resuscitation of local anesthetic induced cardiovascular collapse [1]. Current literature strongly supports the administration of ILE to patients who develop cardiac arrest after receiving an overdose of a local anesthetic such as bupivacaine [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Several mechanisms have been proposed for ILE's antidotal properties including the creation of an expanded lipid compartment in the blood and the modulation of myocardial electrolyte concentrations and/or energy supply [1]. How it reverses the effects of toxic agents or how it may affect subsequently administered therapeutic maneuvers is not clear.…”

Section: Introductionmentioning

confidence: 99%

Intravenous Lipid Emulsion Alters the Hemodynamic Response to Epinephrine in a Rat Model

et al. 2013

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Intravenous lipid emulsion (ILE) is an adjunctive antidote used in selected critically ill poisoned patients. These patients may also require administration of advanced cardiac life support (ACLS) drugs. Limited data is available to describe interactions of ILE with standard ACLS drugs, specifically epinephrine. Twenty rats with intra-arterial and intravenous access were sedated with isoflurane and split into ILE or normal saline (NS) pretreatment groups. All received epinephrine 15 μm/kg intravenously (IV). Continuous mean arterial pressure (MAP) and heart rate (HR) were monitored until both indices returned to baseline. Standardized t tests were used to compare peak MAP, time to peak MAP, maximum change in HR, time to maximum change in HR, and time to return to baseline MAP/HR. There was a significant difference (p=0.023) in time to peak MAP in the ILE group (54 s, 95 % CI 44-64) versus the NS group (40 s, 95 % CI 32-48) and a significant difference (p=0.004) in time to return to baseline MAP in ILE group (171 s, 95 % CI 148-194) versus NS group (130 s, 95 % CI 113-147). There were no significant differences in the peak change in MAP, peak change in HR, time to minimum HR, or time to return to baseline HR between groups. ILE-pretreated rats had a significant difference in MAP response to epinephrine; ILE delayed the peak effect and prolonged the duration of effect of epinephrine on MAP, but did not alter the peak increase in MAP or the HR response.

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Intravenous fat emulsion: A potential novel antidote

Cited by 71 publications

References 44 publications

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

Hemodynamic changes in lipid emulsion therapy (SMOFlipid) for bupivacaine toxicity in swines

Lipid Emulsion Infusion in Resuscitation for Local Anesthetic and Other Drug Overdose

Intravenous Lipid Emulsion Alters the Hemodynamic Response to Epinephrine in a Rat Model

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