Lipid Emulsion, More Than Reversing Bupivacaine Cardiotoxicity: Potential Organ Protection

Abstract

Efforts to develop a treatment for bupivacaine cardiotoxicity led to the discovery that Intralipid, a popular brand of intravenous lipid emulsion, could be used not only as an effective treatment for anesthetic-induced cardiac arrest, but also as a means of reversing many other toxicities. Contradictory data exist regarding the mechanism of action of lipid emulsion, a combination of fatty acids traditionally used in parenteral nutrition. Some researchers attribute the effects to lipophilicity and the individual characteristics of the lipids, while other data demonstrate a direct empowering mechanism through cellular upstream and downstream pathways. Understanding the underlying mechanism of action of this safe source of calories may assist in the development of novel organ protective agents. In this review, some of the direct cardiac effects of lipid emulsion are briefly discussed. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

Evaluation of the efficacy and safety of a new formulation‐lipid emulsion‐based PTX injection: Pharmacokinetics, tissue distributions and anticancer effect on human gastric cancer cells in vitro

“…In this study, we have developed a new drug delivery by diluting PTX into commercial 20% lipid emulsion prior to use. Lipid emulsion is widely used as a parenteral emulsion in the market, and is safe and well tolerated even in low-birth-weight infants and children for nutritional support (Motayagheni et al, 2017). PEG400 is a biocompatible polymer.…”

Intralipid postconditioning in patients of Cardiac surgery undergoing cardioPulmonary Bypass (iCPB): study protocol for a randomized controlled trial

“…Even multiple drugs were assessed [1,20], but none proved to be bene cial in large scale studies for myocardial protection. Now, intralipid may play a novel and potential role in cardioprotection with bright prospect [3][4][5][6][7].…”

“…Improving myocardial energy metabolism can reduce myocardial I/R injury [2]. Since the myocardium relies mainly on fatty acid oxidation (FAO) instead of glycometabolism to provide energy, some experimental studies indicated that supplementing the exogenous FAO substrate can increase the supply of myocardial ATP and thus exert cardioprotection [3][4][5][6][7]. However, preischemic exposure of fatty acids will lead to insu cient FAO during the period of ischemia and cause cardiotoxicity injury subsequently.…”

Intralipid postconditioning in patients of Cardiac surgery undergoing cardioPulmonary Bypass (iCPB): study protocol for a randomized controlled trial

“…Even multiple drugs were assessed [1,20], but none proved to be beneficial in large scale studies for myocardial protection. Now, intralipid may play a novel and potential role in cardioprotection with bright prospect [3][4][5][6][7].…”

“…Improving myocardial energy metabolism can reduce myocardial I/R injury [2]. Since the myocardium relies mainly on fatty acid oxidation (FAO) instead of glycometabolism to provide energy, some experimental studies indicated that supplementing the exogenous FAO substrate can increase the supply of myocardial ATP and thus exert cardioprotection [3][4][5][6][7]. However, preischemic exposure of fatty acids will lead to insufficient FAO during the period of ischemia and cause cardiotoxicity injury subsequently.…”