Download full-text


Available from: Guido Di Gregorio, Dec 31, 2014
  • Source
    • "Subsequent case reports demonstrated rapid reversal of LAST with use of ILE often after standard resuscitative efforts had failed [4,5]. Lipid therapy has also been utilized in patients suffering from poisonings other than those involving LA toxicities [6,7]. Recent research has focused on the efficacy of lipid emulsion in resuscitating patients from overdoses of lipophilic, non-LA agents. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Intravenous lipid emulsion is an established, effective treatment for local anesthetic-induced cardiovascular collapse. The predominant theory for its mechanism of action is that by creating an expanded, intravascular lipid phase, equilibria are established that drive the offending drug from target tissues into the newly formed 'lipid sink'. Based on this hypothesis, lipid emulsion has been considered a candidate for generic reversal of toxicity caused by overdose of any lipophilic drug. Recent case reports of successful resuscitation suggest the efficacy of lipid emulsion infusion for treating non-local anesthetic overdoses across a wide spectrum of drugs: beta blockers, calcium channel blockers, parasiticides, herbicides and several varieties of psychotropic agents. Lipid emulsion therapy is gaining acceptance in emergency rooms and other critical care settings as a possible treatment for lipophilic drug toxicity. While protocols exist for administration of lipid emulsion in the setting of local anesthetic toxicity, no optimal regimen has been established for treatment of acute non-local anesthetic poisonings. Future studies will shape the evolving recommendations for lipid emulsion in the setting of non-local anesthetic drug overdose.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 10/2010; 18(1):51. DOI:10.1186/1757-7241-18-51 · 2.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Alors qu’il existe un nombre croissant de données expérimentales et cliniques en faveur d’une utilisation précoce d’émulsions lipidiques pour le traitement des manifestations cardiotoxiques induites par un surdosage accidentel en agents anesthésiques locaux, les données concernant d’autres agents pharmacologiques lipophiles (notamment certains bêtabloquants ou inhibiteurs calciques) restent plus fragmentaires. Le mécanisme d’action des émulsions lipidiques reste largement débattu: effet de chélation dans un compartiment intravasculaire lipophile, action sur le métabolisme myocardique, action sur les canaux ioniques... Les données expérimentales sont en faveur d’une efficacité des émulsions lipidiques sur les conséquences cardiocirculatoires d’une exposition toxique à des cardiotropes lipophiles, dans des conditions éloignées de la pratique clinique. Aucune comparaison n’a été établie avec des traitements par des antidotes reconnus. Un nombre très limité d’observations cliniques rapporte le succès d’un traitement par émulsions lipidiques d’intoxications graves par cardiotropes qui avaient conduit à une asystolie ou à un collapsus réfractaire au traitement pharmacologique conventionnel. La posologie et la durée du traitement sont empiriques. Les émulsions lipidiques ne répondent pas totalement à la définition d’un antidote. Leur utilisation en première ligne, au-delà de l’exposition accidentelle à des doses toxiques d’anesthésiques locaux, ne peut être actuellement conseillée dans l’attente d’accumulation de données prospectives d’efficacité et de sécurité d’utilisation. While there is an increasing number of both experimental and clinical data supporting the early use of lipid emulsion for the resuscitation of cardiotoxic effects induced by accidental exposure to toxic doses of local anesthetics, data regarding other lipophilic drugs (including some betablockers or calcium-channel antagonists) are scarce. The mechanisms of action of lipid emulsion remain largely debated: lipid sink with sequestration of lipophilic molecules, action on myocardial metabolism, action on ion channels, etc. Experimental data suggest that intravenous lipid emulsion may be helpful in potentially lethal cardiotoxicity due to lipophilic medications, but the experimental conditions appear different from the commonly encountered clinical scenarios of overdose by oral route. No comparison is possible with established antidotal therapies. A limited number of clinical observations reports the successful resuscitation with intravenous lipid emulsion of severe poisonings due to cardiotoxic drugs, after the failure of conventional pharmacological therapy. The dose and duration of lipid emulsion therapy are empirical. Currently, lipid emulsion therapy does not fulfill entirely the criteria for antidotal therapy. Its firstline use, beyond local anesthetic toxicity, cannot be recommended, as more prospective data are required regarding efficacy and safety. Mots clésÉmulsions lipidiques–Cardiotoxicité–Antidote–Anesthésiques locaux–Médicaments lipophiles KeywordsLipid emulsion–Cardiotoxicity–Antidote–Local anesthetics–Lipophilic drugs
    Annales Francaises de Medecine d'Urgence 01/2011; 1(1):26-32. DOI:10.1007/s13341-010-0004-3
  • [Show abstract] [Hide abstract]
    ABSTRACT: Laboratory studies and clinical reports have led to the acceptance of lipid emulsion as an effective treatment of local anesthetic-induced cardiac arrest. This review discusses subsequent clinical reports, relevant laboratory studies and topics for further research. Case reports have confirmed the efficacy of lipid resuscitation for local anesthetic systemic toxicity. Furthermore, lipid emulsion has been used with apparent success early in the spectrum of local anesthetic systemic toxicity to preempt cardiac arrest. The role of lipid emulsion has expanded to treatment of cardiac toxicity due to other lipophilic drugs. This appears to have an acceptable safety profile, although elevated amylase has been reported. Laboratory investigations in animals suggest that concomitant hypoxemia hinders resuscitation attempts, and that epinephrine and vasopressin are more likely to be associated with poor outcomes than lipid. Lipid emulsion infusion appears to be an effective treatment for cardiac toxicity induced by lipophilic medications. Given the difficulties of performing clinical trials, further laboratory investigation and clinical correlation are needed to better define its role in resuscitation.
    Current opinion in anaesthesiology 08/2009; 22(5):667-71. DOI:10.1097/ACO.0b013e32832eb93f · 1.98 Impact Factor
Show more