Intravenous lipid emulsion for local anesthetic toxicity: a review of the literature.

Abstract

INTRODUCTION: The use of intravenous lipid emulsion (IVLE) has been proposed as a new potential treatment for local anesthetic toxicity. Local anesthetics work through reversible binding at sodium channels, and signs and symptoms of toxicity include central nervous system and cardiovascular effects. Cardiovascular collapse is a potential result of local anesthetic toxicity, and is generally resistant to resuscitation efforts with standard measures. DISCUSSION: Various animal studies have been published investigating the use of IVLE in local anesthetic toxicity. IVLE has been shown to increase the lethal dose of bupivacaine required, resuscitate animals that underwent local anesthetic-induced cardiovascular collapse, and more quickly reduce the amount of local anesthetic in the myocardium (compared to administration of control solution). Four human case reports utilizing IVLE for presumed local anesthetic toxicity, with varying presentations, are reviewed. CONCLUSIONS: IVLE has shown to be an interesting prospect for local anesthetic toxicity. Human case reports have shown successful resuscitation with use of IVLE, using varying dosing regimens. More studies are needed to determine the optimal dosing regimen, as well as to determine the potential adverse effects of IVLE when used in this setting.