This publication, along with the above-mentioned animal studies, opened the door to more widespread use of lipid emulsion for emergency treatment of toxicities caused by a range of lipophilic drugs. Within 1 min of a single bolus of lipid emulsion, the patient recovered normal vital signs and ultimately left the hospital with no major neurologic deficit. After 90 min of ventricular tachycardia/fibrillation and narrow complex pulseless electrical activity, which were unresponsive to maximal medical therapy, including high-dose pressors and multiple countershocks, an anesthesiologist recommended using lipid. However, the first use of lipid emulsion therapy in treating nonlocal anesthetic drug toxicity was described by Sirianni et al. , 11who reported on the remarkable rescue of an adolescent near-suicide who suffered a witnessed cardiac arrest hours after hospitalization for a massive overdose of bupropion and lamotrigine. These include models showing a benefit of lipid in treating overdose of tricyclic antidepressants, β-blockers, and calcium channel blockers. Braun, Melsungen, Germany), a mixture of long- and medium-chain fatty acid triglycerides.įollowing the reports of laboratory success in resuscitation from bupivacaine toxicity, lipid emulsion infusion was studied in animal models of a variety of other overdoses, typically those expected to be seen in the emergency department. Though Intralipid (Fresenius Kabi, Uppsala, Sweden) has been the predominant lipid emulsion brand used in instances of lipid resuscitation reported in the medical literature, successful treatment of severe toxicity has also been reported with other formulations, including Liposyn III (Hospira, Lake Forest, IL) and Medialipid (B. Successful treatment of severe cardiac toxicity has been reported in children, including two neonates, one a 2-day-old 9 the oldest patient reported in a successful lipid resuscitation was a 92-yr-old woman in asystole following an infraclavicular block with ropivavcaine. 7, 8This similarly contributes to the debate regarding the mechanisms underlying lipid resuscitation: the metabolic hypothesis would not hold in the case of neurotoxicity because the central nervous system does not normally depend on lipid substrates (see Mechanisms). Lipid infusion can also reverse neurologic signs and symptoms of LAST, including seizures and altered mental status, suggesting that the benefit is not limited to the cardiovascular system.
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