| Treatment of local-anesthetic toxicity with lipid emulsion therapy. | |
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MedLine Citation:
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PMID: 21200058 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Purpose The use of lipid emulsion to treat local-anesthetic toxicity is discussed. Summary Systemic toxicity from local anesthetics is a rare but potentially fatal complication of regional anesthesia. There is increasing evidence that lipid emulsion may be an effective treatment to reverse the cardiac and neurologic effects of local-anesthetic toxicity. A literature search identified seven case reports of local-anesthetic toxicity in which lipid emulsion was used. Lipid emulsion was found to be successful in the treatment of local-anesthetic toxicity associated with various regional anesthetic techniques and multiple local anesthetics. The majority of patients in the case reports reviewed were unresponsive to initial management of local-anesthetic toxicity with standard resuscitative measures, but all recovered completely after receiving lipid emulsion therapy. The initial dose of lipid emulsion administered varied among the case reports, as well as whether a lipid emulsion infusion was started and at what point during resuscitation. Based on the case reports reviewed, an initial bolus dose of 1.5 mL/kg followed by an infusion of 10 mL/min as soon as local-anesthetic toxicity is suspected seems most beneficial. The pharmacokinetics of lipid emulsion therapy in the treatment of local-anesthetic toxicity has not been fully elucidated but likely involves increasing metabolism, distribution, or partitioning of the local anesthetic away from receptors into lipid within tissues. Conclusion Lipid emulsion has been reported useful in the treatment of systemic toxicity caused by local anesthetics. The mechanism of effect is unclear, and evidence for the benefit of lipid therapy in humans is from case reports only. |
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Authors:
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Melissa S Burch; Russell K McAllister; Tricia A Meyer |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists Volume: 68 ISSN: 1535-2900 ISO Abbreviation: Am J Health Syst Pharm Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2011-01-04 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9503023 Medline TA: Am J Health Syst Pharm Country: United States |
Other Details:
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Languages: eng Pagination: 125-9 Citation Subset: IM |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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