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Lipid Rescue Resuscitation from Local Anaesthetic Cardiac Toxicity

  • Review Article
  • Published:
Toxicological Reviews

Abstract

Systemic local anaesthetic toxicity is a rare but potentially fatal complication of regional anaesthesia. This toxicity is due to inhibition of ionotropic and metabotropic cell signal systems and possibly mitochondrial metabolism. It is associated with CNS excitation and, in the extreme, refractory cardiac dysfunction and circulatory collapse. Infusion of lipid emulsion has been shown in animal models to reliably reverse otherwise intractable cardiac toxicity and the mechanism of lipid rescue is probably a combination of reduced tissue binding by re-established equilibrium in a plasma lipid phase and a beneficial energetic-metabolic effect. Recent case reports have suggested the clinical efficacy of lipid infusion by the recovery of patients from intractable cardiac arrest. Future areas of investigation will focus on improved treatment regimes and better understanding of the mechanism of lipid rescue, which might allow superior alternative therapies, or treatment of other toxic events. An educational website has been established to help disseminate information about lipid emulsion therapy and to serve as a medium for physicians to share experiences or thoughts on the method and local anaesthetic toxicity.

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Acknowledgements

The preparation of this review was funded in part by grant NIH R21DA17892. The author has applied for a patent describing certain aspects of this method. A patent has not been granted and no patent licensing arrangements have been made. The author does not have equity interests or stocks in any commercial institution related to this method and does not intend to prohibit or restrict the practice of this method on any patient requiring treatment.

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  1. University of Illinois College of Medicine, Chicago, Illinois, USA

    Guy Weinberg

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  1. Guy Weinberg
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Correspondence to Guy Weinberg.

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Weinberg, G. Lipid Rescue Resuscitation from Local Anaesthetic Cardiac Toxicity. Toxicol Rev 25, 139–145 (2006). https://doi.org/10.2165/00139709-200625030-00001

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  • DOI: https://doi.org/10.2165/00139709-200625030-00001

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