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).
- 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).
- 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.
Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.