- Lipid rescue
Lipid Rescue is a term that has been coined to describe the use of intravenous lipid emulsion to treat severe
local anaesthetic toxicity. This method of Toxicity treatment was invented by DoctorGuy Weinberg in 1998, and had not been widely used until after the first published successful rescue in 2006. Since then more than a dozen case reports have been published. Most recently, lipid therapy held the cover of the May 2008 issue of Anesthesia & Analgesia, where the bulk of the issue had to do with this life saving technique.Though most reports to date have used
Intralipid , a commonly available intravenous lipid emulsion, other emulsions, such as Liposyn and Medialipid have also been shown to be effective.There is ample supporting animal evidenceWeinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology 1998; 88: 1071-5.] Weinberg G, Ripper R, Feinstein DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Regional Anesthesia and Pain Medicine 2003; 28: 198-202..] and human case reports of successful use in this way.Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful Use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006;105:217-8. PMID 16810015] Litz, RJ, Popp M, Stehr S N, Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia 2006;61:800-1.] In the UK, efforts have been made to publicise this use more widelyPicard J, Meek T. Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob. Anaesthesia 2006;61:107-9. PMID 16430560] and lipid rescue has now been officially promoted as a treatment by the Association of Anaesthetists of Great Britain and Ireland. [http://www.aagbi.org/publications/guidelines/docs/latoxicity07.pdf] There is now one published case report of successful treatment of refractory cardiac arrest in
bupropion andlamotrigine overdose using lipid emulsion. [Sirianni AJ, Osterhoudt KC, Calello DP, "et al." Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med 2007. doi|10.1016/j.annemergmed.2007.06.004. PMID 17766009.]References
External links
* [http://www.lipidrescue.org LipidRescue.org: An educational site on the subject]
Wikimedia Foundation. 2010.
