Local anesthetic toxicity and lipid resuscitation in pregnancy

Lipid emulsion has emerged as an effective treatment of local anesthetic-induced cardiac arrest, but its therapeutic application for the obstetric patient requires definition at present. This review discusses clinical reports, relevant laboratory studies, and future directions for the development of an optimal protocol for lipid resuscitation in pregnancy.

Several mechanisms have been postulated to account for the apparent enhanced sensitivity to local anesthetic systemic toxicity during pregnancy. One case report of lipid resuscitation in the pregnant patient demonstrates favorable outcomes and supports the safety of lipid therapy. Current guidelines and case reports propose that a large bolus of lipid at the earliest signs of toxicity may prevent cardiovascular collapse.

As the obstetric demographic becomes older and more obese, new technologies and strategies can assist in controlling maternal death and major morbidity secondary to anesthesia complications. Lipid resuscitation appears to be an effective treatment for toxicity induced by lipophilic medications and may be useful in treating systemic toxicity in the pregnant patient. Obstetric care providers should be aware of lipid resuscitation and consider its use as described by American Society of Regional Anesthesia and Pain Medicine guidelines.