UMEM Educational Pearls

Category: Toxicology

Title: Fat emulsion for treating local anesthetic toxicity

Keywords: Fat emulsion, intralipid, local anesthetic (PubMed Search)

Posted: 12/25/2008 by Ellen Lemkin, MD, PharmD (Updated: 9/24/2021)
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  • Local anesthetics work through reversible binding of sodium channels
  • If inadvertantly administered intravenously or as an overdose, serious CNS and cardiac toxicities can occur, including seizures, arrhythmias, and cardiovascular collapse
  • Fat emulsion has been shown to increase the lethal dose of bupivicaine required, and also resuscitate animals that have local-anesthetic induced cardiac collapse
  • There have been successful case reports of patiets treated with fat emulsion that had cardiac arrest, seizures, and EKG changes. All patients recovered successfully with no neurologic sequale
  • Regimens used in these cases have included bolus doses between 1.2 -2 ml/kg followed by continuous infusions of 0.25 -0.5 ml/kg/min
  • Toxicity may be ameloriated by extracting lipophilic anesthetics from plasma or tissue, or by countering inhibition of myocardial fatty acid oxygenation

References

1. Felice, Kristen. Schumann, Heather. J Med Toxicol. 4(3):184-91, 2008 Sept 4(3):184-91, 2008 Sep.