Lipid Emulsion for Treating Local Anesthetic Systemic Toxicity

• Published in: International journal of medical sciences Vol. 15; no. 7; pp. 713 - 722
• Main Authors: Ok, Seong-Ho, Hong, Jeong-Min, Lee, Soo Hee, Sohn, Ju-Tae
• Format: Journal Article
• Language: English
• Published: Australia Ivyspring International Publisher 01.01.2018
• Subjects: Anesthetics, Local - adverse effects; Animals; Bupivacaine - adverse effects; Fat Emulsions, Intravenous - therapeutic use; Lipids; Resuscitation; Review; lipid emulsion; lipid sink; local anesthetic systemic toxicity; lipid shuttle; bupivacaine
• ISSN: 1449-1907; 1449-1907
• DOI: 10.7150/ijms.22643

Lipid emulsion has been shown to be an effective treatment for systemic toxicity induced by local anesthetics, which is reflected in case reports. A systemic review and meta-analysis confirm the efficacy of this treatment. 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. 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.