Iv lipid emulsion therapy indications11/27/2023 ![]() ![]() ![]() IV lipid emulsion may work for any lipophilic drug toxicity. The article discusses the possible mechanisms of action for IV lipid emulsion as an antidote (as a lipid sink and other possibilities), as well as reviews published cases and controversies in IV lipid emulsion use. The full text of his article is free and I highly suggest that you read the article in its entirety. Weinburg maintains the website which is a fantastic resource on the topic. I discussed these changes back in episode 26.Ī complete review titled Lipid emulsion infusion: resuscitation for local anesthetic and other drug overdose was published by Guy Weinburg in the journal Anesthesiology in 2012. Now that some additional data has been published on the use of IV lipids as a treatment in cardiac arrest from drug toxicity, The 2015 CPR Guidelines Update contains a new recommendation that IV lipid emulsion may be considered in patients with cardiac arrest due to drug toxicity other than LAST who are failing standard resuscitative measures. His words temper the attitude of “I wish I got to do that” that I sometimes feel when I hear about someone else’s “great save”. So as exciting as it is to successfully provide for the pharmacotherapy needs of a crashing patient, I always keep John’s words in mind. Skip forward to 16:00 to hear him talk about this. John Hinds discussed this attitude in a talk he did on resuscitative thoracotomy. But for such an opportunity to present itself, that means something bad must first happen to a patient. It is such a tempting mindset to take – hoping that you get to be involved in a “great save”. On the other hand, I did have that thought of “Oh sure, the fun stuff only happens on my day off”. It was very satisfying to know that our hospital was prepared to respond to this type of crisis. The only adverse event from the lipid emulsion that was noted was his blood draws looked like strawberry milkshakes for 24 hours. He was eventually discharged home neurologically intact. Utimately, IV lipid emulsion was administered. He had a very long code with many shocks and amiodarone administrations. Several uneventful years went by and wouldn’t you know it, on my day off a patient coded in our pre-op area 40 minutes after a ropivicaine block was placed. He was given IV lipid emulsion and within 15 seconds had ROSC.Īfter reading the above cases, I took steps at my hospital to make sure that IV lipid emulsion was available in all critical care and peri-operative PYXIS machines. After 20 minutes of advanced cardiac life support his rhythm had progressed to vtach, vfib, and asystole. The first research using lipids to treat LAST was published in 1998 with a rat model of bupivicaine toxicity and the first published human case report of lipid emulsion to treat LAST was in 2006.Ī 58 year old male had a cardiac arrest after placement of an interscalene block with bupivacaine and mepivacaine. Previous to this case, lipid emulsion had only been used as an antidote for local anesthetic systemic toxicity (LAST). The case presented a compelling temporal relationship between the administration of IV lipids and ROSC. She recovered with near-normal neurologic function. Within 1 minute of receiving lipid emulsion, the patient had return of spontaneous circulation (ROSC). She was coded for 70 minutes, until an anesthesiologist suggested giving IV lipid emulsion. She developed seizure and cardiovascular collapse. An emergency physician showed me an article discussing a case that was reported in Annals of Emergency Medicine.Ī 17 year old female ingested nearly 8 grams buproprion and 4 grams lamotrigine in a suicide attempt. I first heard of the idea of using IV lipid emulsion as an antidote to drug overdose in 2008. Subscribe on iTunes, Android, or Stitcher List which patient care areas in my institution are stocked with IV lipid emulsionģ. Discuss some cases of using IV lipid emulsion for drug toxicityĢ. ![]()
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