Percutaneous bicaval dual lumen cannula for extracorporeal life support

Kim, Woojung; Kwon, Hye Won; Min, Jooncheol; Cho, Sungkyu; Kwak, Jae Gun; Park, June Dong

doi:10.4266/acc.2019.00584

Cited by 2 publications

(3 citation statements)

References 7 publications

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“…As the vasopressors and inotropic agents, which include phenylephrine, norepinephrine, epinephrine, vasopressin, and dopamine, and extracorporeal membrane oxygenation are commonly used for hemodynamic support in drug toxicity, the effects of LE on the hemodynamic responses induced by these drugs as well as their plasma concentrations remain to be determined. 42 In conclusion, LE administration as an adjuvant therapy may be effective in pediatric patients with drug toxicity caused by amitriptyline, flecainide, bupropion, propranolol, lamotrigine, and amlodipine, in which cardiovascular depression and neurologic deterioration are unresponsive to supportive treatment and cardiac support.…”

Section: Discussionmentioning

confidence: 94%

“…Thus, studies regarding optimal dosing regimen and timing of LE administration as adjuvant therapy for drug toxicity induced via enteral administration in pediatric patients are needed. As the vasopressors and inotropic agents, which include phenylephrine, norepinephrine, epinephrine, vasopressin, and dopamine, and extracorporeal membrane oxygenation are commonly used for hemodynamic support in drug toxicity, the effects of LE on the hemodynamic responses induced by these drugs as well as their plasma concentrations remain to be determined 42 …”

Section: Discussionmentioning

confidence: 99%

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Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients

2022

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Objective: Lipid emulsion (LE) has been used to treat children with cardiovascular collapse induced by toxic doses of nonlocal anesthetics with high lipid solubility. We aimed to analyze case reports on LE administration for resuscitation of toxicity induced by these drugs in pediatric patients.Methods: Case reports involving pediatric patients undergoing LE treatment for toxicity caused by nonlocal anesthetic drugs until December 31, 2021, were searched through PubMed and Scopus using the following terms: "toxicity, or intoxication, or poisoning, or overdose" and "LE or intralipid."Results: Twenty-eight cases on LE treatment for toxicity induced by nonlocal anesthetic drugs in pediatric patients (younger than 19 years) were retrieved. The total number of patients was 31. Lipid emulsion treatment was carried out during toxicity caused by amitriptyline, flecainide, bupropion, propranolol, and lamotrigine, which was unresponsive to supportive treatment. These drugs are highly lipid-soluble and inhibit cardiac sodium channels, which is similar to pharmacological properties of the local anesthetic bupivacaine. The most frequent method of delivery involved bolus administration followed by continuous infusion; 1.5 mL/kg LE administration followed by 0.25 mL/kg/min LE was most frequently used. Lipid emulsion improved various symptoms of drug toxicity in 29 patients (29/31, 93.54%), and symptoms were improved in 14 patients (14/31, 45.16%) within an h after LE administration. The trend in frequency of improved symptoms after LE treatment was as follows: the cardiovascular symptom alone > symptoms of the central nervous system alone > symptoms of the cardiovascular and central nervous systems. The adverse effects of LE treatment in the reported cases were hypertriglyceridemia, mild pancreatitis, and elevated levels of aspartate and alanine aminotransaminases.Conclusions: Lipid emulsion treatment may be effective in ameliorating intractable cardiovascular depression when systemic toxicity caused by drugs, including cardiac sodium channel blockers, is unresponsive to supportive treatments.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients

2022

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“…While significant research regarding LE resuscitation has been conducted, further studies are needed to clarify the following aspects. First, as LE decreases the area under the drug concentration–time curves and the half-life of lipid-soluble drugs, the therapeutic concentration of some lipid-soluble drugs administered for supportive treatment (for example, hemodynamic support) during drug toxicity may be reduced after LE administration [ 35 , 93 ]. Thus, as vasopressors and inotropic drugs, including epinephrine, norepinephrine, phenylephrine, vasopressin, and dopamine, are commonly used for hemodynamic support during drug toxicity, the effects of LE on the blood pressure response evoked by these drugs and their plasma concentrations are undefined.…”

Section: Methodsmentioning

confidence: 99%

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

Lee

Sohn

2023

Korean J Anesthesiol

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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.

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Percutaneous bicaval dual lumen cannula for extracorporeal life support

Cited by 2 publications

References 7 publications

Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients

Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients

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

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