Lipid Emulsion Treatment of Nonlocal Anesthetic Drug Toxicity

Ok, Seong-Ho; Park, Miyeong; Sohn, Ju-Tae

doi:10.1097/mjt.0000000000001300

Cited by 12 publications

(24 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…properties of bupivacaine [15,39,44]. According to analysis of case reports, the intractable cardiovascular depression caused by toxic dose of above mentioned non-local anesthetic drug with high lipid solubility was ameliorated by LE treatment [13][14][15]. Moreover, LE reversed the decreased left ventricular systolic pressure (+dP/dt) and systolic blood pressure induced by levobupivacaine toxicity in Langendorff-isolated heart preparation [45].…”

Section: Positive Inotropic Effectmentioning

confidence: 99%

“…The initial upper recommended dose of LE is approximately 12 mL/kg [2]. In spite of difference of toxicokinetic induced by local anesthetic and non-local anesthetic (mainly via oral administration), case reports regarding LE treatment as adjuvant drug for drug toxicity caused by non-local anesthetic drug frequently used the recommended LE dosing regimen for LAST [14,15]. On the other hand, according to analysis of case reports, LE dosing regimen used for treatment of drug toxicity caused by non-local anesthetic via oral administration was various [14,15].…”

Section: Suggested Dosing Regimen For Le Treatmentmentioning

confidence: 99%

“…Thus, these days, the availability of Intralipid in hospitals is limited owing to the above-mentioned causes, but SMOFlipid and ClinOleic used for parenteral nutrition are comparatively more available. Many cases reported that Intralipid was most frequently used to treat drug toxicity caused by local or non-local anesthetic drugs [14,15,86]. However, other alternative preparation of LE, which includes Lipofundin MCT/LCT, SMOFlipid and Clinoleic, can be used for the treatment of urgent and critical cardiovascular depression caused by toxic dose of local anesthetic or non-local anesthetic drugs [14,15,86,87].…”

Section: Kind Of Lementioning

confidence: 99%

“…LE administration in LAST is currently performed at the incipient stage compared with past [2]. Moreover, currently, LE as adjuvant drug has been reported to alleviate cardiovascular collapse and central nervous system symptom caused by non-local anesthetic drugs with highly lipid solubility (log P: > 2), which are unresponsive to supportive treatment [13][14][15]. Thus, this review's goals were to provide the detailed underlying mechanism of LE resuscitation in drug toxicity including LAST, and LE treatment for drug toxicity, and to discuss further research direction.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review

Lee

Sohn

2023

Korean J Anesthesiol

Self Cite

View full text Add to dashboard Cite

Currently, lipid emulsion (LE) is widely used in the treatment of local anesthetic systemic toxicity (LAST). Additionally, LE has been shown to be effective to ameliorate intractable cardiovascular collapse evoked by toxicity of lipid soluble non-local anesthetic drug. The goal of this review focused on the underlying mechanism of LE treatment in the drug toxicity including LAST, LE treatment, and further research direction. We searched the relevant articles using following keywords: "local anesthetic systemic toxicity or LAST or toxicity or intoxication or poisoning" and "Intralipid or lipid emulsion". The underlying mechanism associated with LE treatment can be divided into indirect and direct effects. Lipid shuttle (indirect effect) of LE treatment is the commonly accepted mechanism: lipid phase of LE absorbs highly lipid soluble drugs ( bupivacaine) from heart and brain, and then LE containing lipid soluble drugs is delivered to muscle, adipose tissue, and liver for storage and detoxification. The direct effects are as follows: inotropic effects, supply of fatty acid, attenuation of mitochondrial dysfunction, glycogen synthase kinase-3β phosphorylation, and inhibition of nitric oxide. These mechanisms seem to synergistically act to alleviate drug toxicity. The recommended LE dosage for LAST is as follows: bolus administration of 20% LE 1.5 ml/kg over 2 to 3 min followed by 20% LE infusion 0.25 ml/kg/min. LAST most occurs via intravenous administration. However, as drug toxicity caused by non-local anesthetic drugs occurs via oral administration, further study is needed to examine the optimal dosing schedule of LE treatment for non-local anesthetic drug toxicity.

show abstract

Section: Positive Inotropic Effectmentioning

confidence: 99%

Section: Suggested Dosing Regimen For Le Treatmentmentioning

confidence: 99%

Section: Kind Of Lementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review

Lee

Sohn

2023

Korean J Anesthesiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, LE may be effective in treating the cardiotoxicity observed after chloroquine and hydroxychloroquine treatment in patients suffering from coronavirus disease 2019 [20,21]. LE was reported to be effective in alleviating cardiovascular depression caused by a toxic dose of highly lipid soluble drugs that inhibit cardiac sodium or potassium channels, which include amitriptyline, bupropion, lamotrigine, and flecainide [10,41,42]. Thus, LE may be a valuable adjuvant drug in the treatment of patients with intractable cardiovascular depression caused by toxicity of the afore-mentioned drugs in the operating room or intensive care unit.…”

Section: Similar To Previous Reports Involving Bupivacaine Le and The...mentioning

confidence: 99%

Lipid emulsion inhibits the cardiac toxicity caused by chloroquine via inhibition of reactive oxygen species production

Lee¹,

Ok²,

Ahn³

et al. 2023

Korean J Anesthesiol

View full text Add to dashboard Cite

Background: Lipid emulsion (LE) is effective in treating intractable cardiac depression induced by the toxicity of highly lipid-soluble drugs including local anesthetics. However, the effect of LE on chloroquine-evoked cardiac toxicity remains unclear. This study aimed to examine the effect of Lipofundin MCT/LCT, an LE, on the cardiotoxicity caused by chloroquine in H9c2 rat cardiomyoblasts and elucidate the underlying cellular mechanism. Methods: The effects of chloroquine (1 × 10 -4 M), LE, and the reactive oxygen species (ROS) scavengers mitotempo and N-acetyl-L-cysteine (NAC), alone or combined, on cell viability and migration, apoptosis, ROS production, calcium levels, mitochondrial membrane potential, and adenosine triphosphate (ATP) were examined. Additionally, the effects of LE on the activities of catalase (CAT), malondialdehyde (MDA), and superoxide dismutase (SOD) induced by chloroquine were assessed. Results: Pretreatment with LE, mitotempo, or NAC reversed the reduction in cell migration and viability, mitochondrial membrane potential, and ATP levels evoked by chloroquine, and inhibited the increase in cleaved caspase-3, ROS, and calcium concentration induced by chloroquine. LE inhibited the increase in Bax expression, TUNEL-positive cells, MDA activity, and late apoptosis, and reversed the reduction in SOD and CAT activity induced by chloroquine. Chloroquine did not significantly affect cleaved caspase-8 expression, and LE did not significantly affect chloroquine concentration.Conclusion: Collectively, these results suggest that LE with 50% long-chain and 50% mediumchain fatty acids inhibits the cardiotoxicity and late apoptosis induced by chloroquine toxicity via the intrinsic mitochondrial apoptotic pathway, which is associated with direct inhibition of ROS production.

show abstract

Lipid emulsion treatment of cardiotoxicity caused by calcium channel blocker and beta-blocker

Sohn

2022

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

Lipid Emulsion Treatment of Nonlocal Anesthetic Drug Toxicity

Cited by 12 publications

References 29 publications

Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review

Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review

Lipid emulsion inhibits the cardiac toxicity caused by chloroquine via inhibition of reactive oxygen species production

Lipid emulsion treatment of cardiotoxicity caused by calcium channel blocker and beta-blocker

Contact Info

Product

Resources

About