[Lipid emulsion therapy for local anaesthetic toxicity. (LipidRescue)]

Intoxication due to local anaesthetic drugs poses a rare but potentially life-threatening complication. In particular long-acting local anaesthetics can cause refractory cardiac arrest due to their lipophilic properties. This is often preceded by neurological symptoms such as confusion, vertigo and tonic-clonic seizures. The clinical efficacy of lipid emulsions in resuscitation from local anaesthetic toxicity has been documented in multiple publications. The injection of local anaesthetics should be stopped immediately upon the first presentation of symptoms. Securing the airway is mandatory to avoid hypoxia and concurrent acidosis. A seizure should be controlled with adequate doses of anticonvulsants. In case of cardiac arrest standard protocols for cardiopulmonary resuscitation have to be implemented immediately. The use of lipid emulsion can then be initiated as a supplement to standard resuscitation. It is recommended that lipid emulsions are instantly accessible in all facilities where local anaesthetics are administered.