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Lipid emulsion in local anesthetic toxicity
1aDepartment of Emergency Medicine, Waikato Hospital, Hamilton, New Zealand bDepartment of Intensive Care Medicine, Tamworth Base Hospital, North Tamworth, New South Wales, Australia cSchool of Pharmacy, University of Auckland, Auckland, New Zealand.
Current Opinion in Anaesthesiology
|July 11, 2017
Summary
Intravenous lipid emulsion (ILE) is the first-line treatment for local anesthetic systemic toxicity (LAST), offering survival benefits. Further high-quality human data is needed to refine clinical recommendations for ILE in LAST.
Area of Science:
- Anesthesiology
- Toxicology
- Pharmacology
Background:
- Regional anesthesia offers patient benefits but carries risks like local anesthetic systemic toxicity (LAST).
- Intravenous lipid emulsion (ILE) is endorsed for LAST treatment based on existing data.
- Objective interrogation of published literature is now possible.
Purpose of the Study:
- To review the current literature on the efficacy of ILE in treating LAST.
- To analyze the mechanism of action and clinical evidence supporting ILE for LAST.
Main Methods:
- Systematic review of animal studies and human case reports.
- Meta-analysis of animal models of LAST.
- Analysis of human models of LAST.
Main Results:
- ILE shows a positive effect on survival in animal models of LAST.
- Evidence suggests a positive pharmacokinetic effect of lipid in human models of LAST.
- Systematic reviews provide reserved endorsement for bupivacaine toxicity, weak support for other local anesthetics, and neutral recommendations for other poisonings.
Conclusions:
- ILE remains the first-line therapy for LAST, alongside standard resuscitation.
- High-quality human data is required to solidify clinical recommendations for ILE in LAST.
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