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Lipid emulsion for local anaesthetic toxicity
Article first published online: 16 OCT 2006
Volume 61, Issue 11, pages 1116–1117, November 2006
How to Cite
Picard, J., Meek, T., Weinberg, G. and Hertz, P. (2006), Lipid emulsion for local anaesthetic toxicity. Anaesthesia, 61: 1116–1117. doi: 10.1111/j.1365-2044.2006.04841.x
- Issue published online: 16 OCT 2006
- Article first published online: 16 OCT 2006
Lipid emulsion has now twice been reported to end otherwise refractory cardiac arrest in patients apparently intoxicated by local anaesthetic. Moreover, it has reversed the effects of ropivacaine and mepivacaine, as well as racemic bupivacaine intoxication [1, 2]. As properly designed studies for treatment of severe local anaesthetic toxicity would be unethical, these case reports provide the best possible clinical evidence of the efficacy of lipid emulsion therapy.
We are encouraged by personal communications and publications  indicating that many anaesthesia departments have decided to stock a ‘lipid rescue’ pack in their theatres and labour wards – a decision that could potentially save lives. Clinicians are likely to seek recommendations for preparing and delivering such a novel treatment. Yet, over time, journal editors might weary of individual case reports, risking that lessons from the future use of lipid emulsion could also be lost to the community of practising anaesthetists. Anticipating such needs, we are collaborating to establish an educational website, http://www.lipidrescue.org, for the purposes of collecting and disseminating information about this use for lipid emulsion in particular and local anaesthetic toxicity in general. This site will contain sample protocols for lipid treatment and suggestions for establishing its use in the clinical setting. It will also serve as a portal for clinicians to exchange ideas on various facets of local anaesthetic toxicity and its treatment. Finally, it will include a means for clinicians to submit case reports of lipid emulsion use, in the hope that we may draw conclusions and refine treatments with time.
Many important questions about this nascent technology remain unanswered  and hopefully continued research in animal models of local anaesthetic toxicity will help improve therapeutic effectiveness, identify the mechanisms of lipid reversal and determine whether the principle can be extended to treat other types of toxicity. Therefore the website will also report on recent advances and research on lipid emulsion treatment of local anaesthetic toxicity with links to the relevant articles.
We believe that the recent case reports vindicate our early enthusiasm for lipid therapy [5–7] and provide support for our recommendation that lipid emulsion be immediately available wherever local anaesthetics are administered. We hope that the website initiative will reinforce the scientific foundation of lipid rescue as the initial burst of case reports passes and will improve general awareness and acceptance of the method.