Use of intralipid for local anesthetic toxicity in neonates

Patil, Kanchan

doi:10.1111/j.1460-9592.2011.03670.x

Cited by 8 publications

(5 citation statements)

References 9 publications

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“…In human medicine, lipids are used commonly as parenteral nutrition in premature infants to provide a concentrated source of energy and essential fatty acids (Deshpande and Simmer 2011). There are no specific guidelines on the use of lipids in the treatment of poisoning in neonates (Patil 2011), and experience in young individuals in both human and veterinary medicine is limited. The use of lipid infusion in moxidectin toxicity in a puppy has been described, and although it was older (16 weeks of age) it was smaller (3.2 kg compared with 4 kg) than the puppy described in Case 6.…”

Section: Discussionmentioning

confidence: 99%

Lipid infusion in the management of poisoning: a report of 6 canine cases

Bates¹,

Chatterton²,

Robbins³

et al. 2013

Vet Record Case Reports

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Intravenous administration of lipid is a relatively new treatment in the management of toxicity from lipophilic compounds. It is used in human medicine in the treatment of toxicity from lipophilic local anaesthetics and cardiotoxic drugs and can result in dramatic improvement in clinical status. We present six cases of poisoning in dogs successfully treated with lipid infusion after ingestion of ivermectin (3), moxidectin (2) and baclofen (1). The dogs ranged in age from eight weeks to 14 years, and weighed 4–30 kg. Intravenous lipid therapy was started between six and eight hours and 22 hours after ingestion, and all the dogs responded well. In four dogs, there was clinical improvement within one hour; one had improved within two hours and the other within 4.5 hours of lipid administration. The only adverse effect of lipid infusion reported was mild swelling and pain after extravasation in one case which resolved with conservative management. All the dogs were discharged within 24–52 hours after exposure (7–46 hours after the start of lipid administration), and none developed any apparent sequelae.

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Section: Discussionmentioning

confidence: 99%

Lipid infusion in the management of poisoning: a report of 6 canine cases

Bates¹,

Chatterton²,

Robbins³

et al. 2013

Vet Record Case Reports

View full text Add to dashboard Cite

show abstract

“…A concentration gradient develops between tissue and blood which causes local anesthetics to move from the heart or brain (areas of high concentrations) to the “lipid sink”. Because of the increasing practice of local anesthesia, further research in safe elimination therapy as intralipid in neonates is therefore needed [9]. By the time the diagnosis was established in this current case, the patient was already recovered and elimination therapy was not necessary.…”

Section: Discussionmentioning

confidence: 97%

Severe Cardiorespiratory and Neurologic Symptoms in a Neonate due to Mepivacaine Intoxication

Mooren

Quint

Knobbe

et al. 2019

Case Reports in Pediatrics

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Local anesthesia with mepivacaine is used for vaginal deliveries and for minor surgeries of the vagina and perineum as repair of an episiotomy or perineal laceration. Neonatal intoxication caused by local anesthesia with mepivacaine for maternal episiotomy has been rarely reported. We present a case of a term female infant with unexplained cardiorespiratory distress and several neurologic findings, including seizures, one hour after birth. Electrocardiogram showed a second-degree atrioventricular block and a left-bundle branch block. Blood measures in the patient revealed a high mepivacaine level following local anesthesia for maternal episiotomy. Because of the increasing practice of local anesthesia, high awareness for neonatal intoxication and further research in safe elimination therapy in neonates is needed.

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“…Emulating the operative environment, with training ancillary staff in the pediatric or neonatal intensive care units, and having access to emergency equipment and medications may support safety of regional anesthetic techniques in other venues. Monitoring patients’ vital signs during and after procedures (or during subsequent infusions) is an essential practice in regional anesthesia, regardless of timing or setting, as is having emergency drugs available (including intralipid 67 ) to treat local anesthetic systemic toxicity.…”

Section: Discussionmentioning

confidence: 99%

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Relland

Neel

Gehred

et al. 2020

Pediatric Anesthesia

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This review examines the quality and quantity of literature regarding methods that measure efficacy in the context of reported safety of regional anesthesia techniques in preterm and term infants <1 year of age. Because the role of anesthesiologists continues to expand outside the operating room, we focused on all relevant settings with assessments that extend beyond 24 hours from the intraoperative period. All study designs were included from a search of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from 1946 to the end of 2019. A total of 31 studies were included (n = 1038 participants), consisting of five randomized controlled trials and 26 observational studies. Twenty‐three studies examined neuraxial procedures, seven studies examined peripheral procedures, and one study examined both. Efficacy measures included pain assessment tools, analgesic use, and factors pertaining to the recovery of patients. Safety was assessed in multiple systems (neurological, cardiovascular, respiratory, pathological) and with vital signs and/or measures of systemic toxicity. Evidence in this review establishes that neuraxial and peripheral anesthesia treatments may be applied to neonates and infants with a high degree of safety. However, large gaps in the consistency of methods used to assess pain in these studies underline the need for rigorous prospective efficacy studies of these techniques in this population. This systematic review was registered on PROSPERO (CRD42018114466).

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Use of intralipid for local anesthetic toxicity in neonates

Cited by 8 publications

References 9 publications

Lipid infusion in the management of poisoning: a report of 6 canine cases

Lipid infusion in the management of poisoning: a report of 6 canine cases

Severe Cardiorespiratory and Neurologic Symptoms in a Neonate due to Mepivacaine Intoxication

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

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