Lipid Rescue

1. Lipid Rescue Treatment for Local Anesthetic-Induced Cardiac Arrest

2. Current Data • 20 out of 10,000 peripheral nerve blocks • 4 out of 10,000 epidural block Result in systemic local toxicity requiring treatment!

3. www.lipidrescue.org • For more information on local toxicity

4. Initial symptoms of Local Anesthetic Overdose • Mild hypertension • Tachycardia • Mild Agitation • Confusion

5. Cardiac Toxicity • Hypotension • Atrioventricular Conduction Delay • Idioventricular Rhythms • Respiratory Depression • Cardiovascular Collapse

6. Local Anesthetic Toxicity • Can Occur after Ingestion • IV Administration • Topical Application

7. 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.

8. Conclusions • 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 toxicity.