Intravenous Lipid Emulsion as Antidote Beyond Local Anesthetic Toxicity: A Systematic Review

Authors

  • Grant Cave MBChB, FACEM,

    1. From Hutt Hospital (GC), Lower Hutt, New Zealand; the University of Otago, Wellington School of Medicine and Health Sciences (GC), Wellington, New Zealand; Monash Medical Centre (GC), Clayton Road, Melbourne, Victoria, Australia; and the Department of Emergency Medicine, Waikato Hospital (MH), Hamilton, New Zealand.
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  • Martyn Harvey MBChB, FACEM

    1. From Hutt Hospital (GC), Lower Hutt, New Zealand; the University of Otago, Wellington School of Medicine and Health Sciences (GC), Wellington, New Zealand; Monash Medical Centre (GC), Clayton Road, Melbourne, Victoria, Australia; and the Department of Emergency Medicine, Waikato Hospital (MH), Hamilton, New Zealand.
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  • Presented at The Joint Faculty of Intensive Care Medicine ASM, Brisbane, Australia, June 12–14, 2009.

Address for correspondence and reprints: Martyn Harvey, MBChB, FACEM; e-mail: harveym@waikatodhb.govt.nz.

Abstract

Objectives:  The objective was to asses the efficacy of lipid emulsion as antidotal therapy outside the accepted setting of local anesthetic toxicity.

Methods:  Literature was accessed through PubMed, OVID (1966–February 2009), and EMBASE (1947–February 2009) using the search terms “intravenous” AND [“fat emulsion” OR “lipid emulsion” OR “Intralipid”] AND [“toxicity” OR “resuscitation” OR “rescue” OR “arrest” OR “antidote”]. Additional author and conference publication searches were undertaken. Publications describing the use of lipid emulsion as antidotal treatment in animals or humans were included.

Results:  Fourteen animal studies, one human study, and four case reports were identified. In animal models, intravenous lipid emulsion (ILE) has resulted in amelioration of toxicity associated with cyclic antidepressants, verapamil, propranolol, and thiopentone. Administration in human cases has resulted in successful resuscitation from combined bupropion/lamotrigine-induced cardiac arrest, reversal of sertraline/quetiapine-induced coma, and amelioration of verapamil- and beta blocker–induced shock.

Conclusions:  Management of overdose with highly lipophilic cardiotoxic medications should proceed in accord with established antidotal guidelines and early poisons center consultation. Data from animal experiments and human cases are limited, but suggestive that ILE may be helpful in potentially lethal cardiotoxicity or developed cardiac arrest attributable to such agents. Use of lipid emulsion as antidote remains a nascent field warranting further preclinical study and systematic reporting of human cases of use.

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