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Lipid Resuscitation: A Life-Saving Antidote for Local Anesthetic Toxicity

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Local anesthetic toxicity is a rare, but potentially lethal, complication of regional anesthesia that cannot be prevented by any single measure. It is associated with CNS excitation and can lead to refractory cardiac dysfunction and collapse. The development of lipid emulsion for the treatment of anesthetic-induced toxicity resulted from a set of observations during a study on the potent, lipophilic drug bupivacaine and its associated clinical risk of intransigent cardiac toxicity in otherwise healthy individuals. Subsequent laboratory studies and clinical reports have shown that infusion of lipid can reliably reverse toxicity from potent local anesthetics as well as other drugs. The underlying mechanisms of lipid resuscitation may be a combination of a ‘lipid sink’ and metabolic effect. Lipid rescue has led to a reduction in fatalities associated with severe systemic toxicity, but continued research is necessary for a better mechanistic understanding. Increased physician awareness and education, as well as optimized treatment protocols, will significantly reduce the rate of morbidity and mortality from local anesthetic toxicity.

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Keywords: American Society of Regional Anes-thesia; Antidote; CNS excitation; Fat emulsion; The ‘lipid sink’ mechanism; adenosine triphosphate; agitation; amiodar-one; amiodarone; atropine; beta-oxidation; bupivacaine-induced cardiac; bupro-prion; cardiovascular collapse; carnitine acylcarnitine translocase; carnitine-dependent pathway; catecholamines; clinical dilemma; cocaine; dizziness; drowsiness; electrocardiogram; electrostatic interactions; epinephrine; fibrillation; generalized; heart arrest; hemodynamic stability; incremental injection; intravenous; isovaleric; lamotrigine; lipid infusion; lipid therapy; lipophilic drug bupivacaine; liposomes; local anesthetics; loss of conscious-ness; mepivacaine. Advanced Cardiac Life Support (ACLS); nonical anesthetics; overdose; parti-tion coefficient; physicochemical property; refractory cardiac arrest; refractory cardiac dysfunction; resuscitation; seizure; severe hypotension; tissue blood flow; toxicity; treating cardiotoxicity; vascular density; vasopressin; ventricular dysrhythmias; ventricular tachycardia

Document Type: Research Article

Publication date: 01 February 2011

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  • Current Pharmaceutical Biotechnology aims to cover all the latest and outstanding developments in Pharmaceutical Biotechnology. Each issue of the journal contains a series of timely in-depth reviews written by leaders in the field covering a range of current topics in both pre-clinical and clinical areas of Pharmaceutical Biotechnology. Current Pharmaceutical Biotechnology is an essential journal for academic, clinical, government and pharmaceutical scientists who wish to be kept informed and up-to-date with the latest and most important developments.
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