The current review includes the following: 1) an introduction, 2) a list of the proposed mechanisms, 3) a discussion of the best lipid emulsion treatment for reversal of local anesthetic toxicity, 4) a description of the effect of epinephrine on lipid emulsion-mediated resuscitation, 5) a description of the recommended lipid emulsion treatment, and 6) a conclusion.īupivacaine lipid emulsion lipid shuttle lipid sink local anesthetic systemic toxicity. Rosenblatt et al 5 reported the first clinical application of lipid emulsion therapy in treating LAST. Because of potential publication biases, there are few reports concerning the failure of ILE. Lipid emulsion therapy Intravenous lipid emulsion (ILE) is now recognised as an effective treatment for local-anaesthetic-induced cardiovascular collapse.

Investigators have suggested mechanisms associated with the lipid emulsion-mediated recovery of cardiovascular collapse caused by local anesthetic systemic toxicity these mechanisms include lipid sink, a widely accepted theory in which highly soluble local anesthetics (particularly bupivacaine) are absorbed into the lipid phase of plasma from tissues (e.g., the heart) affected by local-anesthetic-induced toxicity enhanced redistribution (lipid shuttle) fatty acid supply reversal of mitochondrial dysfunction inotropic effects glycogen synthase kinase-3β phosphorylation associated with inhibition of the mitochondrial permeability transition pore opening inhibition of nitric oxide release and reversal of cardiac sodium channel blockade. Objective: Although anecdotal reports suggest that intravenous lipid emulsion (ILE) therapy is effective in a large variety of overdoses, the few controlled human trials published to date yielded disappointing results.

A systemic review and meta-analysis confirm the efficacy of this treatment. Intralipid Intravenous lipid emulsion therapy Lipid emulsion Local anesthetic systemic toxicity.Lipid emulsion has been shown to be an effective treatment for systemic toxicity induced by local anesthetics, which is reflected in case reports. Intravenous lipid emulsion therapy provides a multimodal resuscitation benefit that includes both scavenging (eg, the lipid shuttle) and nonscavenging components. The education of clinicians regarding the beneficial and varied roles of Intralipid therapy in different clinical settings is warranted, particularly in terms of the potential for Intralipid therapy to reverse the toxicities of non-local anesthetic drugs. These recom-mendations are based on the results of four systematic reviews,14 derived from a comprehensive analysis of the published evidence and further followed by an expert consensus. These case reports included 49 separate drug overdose cases involving ten separate drug classes which were successfully reversed with Intralipid. tions regarding the use of intravenous lipid emulsion therapy in poisoning for a preselected set of toxins. To meet the objective of describing the growing number of indications for Intralipid therapy and any diverse effects and/or failures of Intralipid therapy in reversing multiple drug toxicities, we queried several Internet search engines with the key words 'intravenous lipid emulsion therapy,' 'Intralipid,' 'lipid emulsion,' and 'local anesthetic systemic toxicity,' resulting in the identification of 31 case reports for descriptive analysis. Some of these varied drug groups include antipsychotics, antidepressants, antiarrhythmics, and calcium channel blockers. Intravenous lipid emulsion (ILE Intralipid) therapy, a standard treatment in local anesthetic toxicity, has demonstrated therapeutic efficacies for a number of different drug class-mediated toxicities.