Lipid Rescue by u8ONa2


									      Lipid Rescue
Treatment for Local Anesthetic-
    Induced Cardiac Arrest
        Current Data
• 20 out of 10,000 peripheral nerve

• 4 out of 10,000 epidural block

Result in systemic local toxicity
 requiring treatment!
• For more information on local
Initial symptoms of Local
  Anesthetic Overdose
•   Mild hypertension
•   Tachycardia
•   Mild Agitation
•   Confusion
        Cardiac Toxicity
•   Hypotension
•   Atrioventricular Conduction Delay
•   Idioventricular Rhythms
•   Respiratory Depression
•   Cardiovascular Collapse
     Local Anesthetic
• Can Occur after Ingestion
• IV Administration
• Topical Application
   2 proposed methods of
   How Intralipids Work
• 1st…The lipid infusion creates a lipid phase, or “lipid sink,” in
  the plasma to which local anesthetics can partition into.
• The 2nd possible mechanism is reversal of mitochondrial
  fatty acid transport inhibition. It is believed that local
  anesthetics inhibit carnitine acylcarnitine translocase
  (CACT), an enzyme used in mitochondrial fatty acid
  metabolism and transport. Because fatty acids are involved
  in 80% to 90% of cardiac adenosine 5'-triphosphate (ATP)
  synthesis, inhibition of CACT may contribute to cardiac
  toxicity. Lipid infusion may increase the intracellular fatty
  acid content enough to overcome the inhibition of the CACT
  enzyme by the anesthetic.
• Lipid infusion appears to reverse
  cardiotoxicity rapidly, is easier than
  cardiopulmonary bypass.
• Lipid emulsion is readily available at a much
  lower cost.
• Lipid rescue therapy is to be reserved
  until ACLS procedures have been
  unsuccessful in cases of local anesthetic

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