A response to ‘Lipid emulsion to treat bupivacaine toxicity’

Authors

  • J. Picard,

  • T. Meek


We read with glee the letter from Drs Dalgleish and Kathawaroo promoting Intralipid as an antidote to local anaesthetic intoxication [1]. The work published by Dr Weinberg's team has impressed us, too – most recently a bolus and then infusion of Intralipid has been shown effective in a canine model of overwhelming inadvertent intravenous injection of local anaesthetic [2]. Given the rarity and severity of local anaesthetic overdose, higher grade scientific evidence is unlikely.

We have therefore introduced 500 ml bags of Intralipid 20% to our recovery and labour wards. In each unit, a single 500 ml bag nestles close to the O negative blood and another crucial antidote: dantrolene. (The Intralipid costs less than £20, and can be returned to pharmacy to be included in total parenteral nutrition towards the end of its shelf life of up to a year.)

Attached to each bag is a laminated card describing the dosage suggested by Dr Weinberg: ‘1 ml.kg−1 over 1 min, while continuing chest compressions…repeated every 3–5 min to a maximum of 3 ml.kg−1, converting at that point, or earlier with evidence of recovery, to a continuous infusion of lipid 20% at a rate of 0.25 ml.kg−1.min−1, given until haemodynamic recovery’[3].

We would exhort colleagues who administer large doses of local anaesthetic to do the same.

Ancillary