Intravenous lipid emulsion

Intravenous lipid emulsion (IVLE) is a sterile emulsion of soyabean oil in water, used in parenteral nutrition. It is a novel antidote which requires further study but may have a role to play in the resuscitation of patients with refractory cardiac arrest induced by local anaesthetics that are resistant to standard protocols. It may also have a role when standard therapy has failed in the arrest of a propranolol, tricyclic antidepressant and verapamil overdose (limited evidence).

Administration:

• Continue standard resuscitation
• Give 1-1.5 ml/kg IVLE 20% as an IV bolus over 1 minute
• Repeat bolus at 3-5 minute intervals if required (x2 max) then
• Infuse IVLE 0.25 ml/kg/minute until haemodynamic stability is restored
• Increase to 0.5 ml/kg/minute if hypotension persists, doses above 8ml/kg are unlikely to be beneficial
• Therapeutic end points include return of spontaneous circulation and stabilisation of haemodynamics (infusions may need to be restarted if hypotension returns post cessation).

References

• The Association of Anaesthetists of Great Britain and Ireland.  Guidelines for the management of severe local anaesthetic toxicity. August 2007; Available: http://www.aagbi.org.
• Weinberg G. Lipid rescue resuscitation from local anaesthetic cardiac toxicity. Toxicological Reviews 2006; 25(3):139-145.
• Turner-Lawrence DE, Kerns W. Intravenous fat emulsion: a potential novel antidote. Journal of Medical Toxicology 2008; 4(2):109-114.
• Felice KL, Schumann HM. Intravenous lipid emulsion for local anaesthetic toxicity: a review of the literature. Journal of Medical Toxicology 2008; 4(3):184-191.