John Picard and Tim Meek wrote a very elegant letter to the editor published in the most recent A&A in response to the recently  published survey by Corcoran et al on the use of lipidrescue resuscitation in US academic anesthesia departments. The main points of the survery were that (at that time) only a small fraction of centers were prepared or willing to infuse lipid in a crisis scenario and (still a problem) there was no consensus on how to treat severe LA toxicity. The letter of Picard and Meek points out the parallels of acceptance of lipid with that of dantrolene for MH 30 + years ago. They also mention www.lipidrescue.org and offer the first official note to the effect that the AAGBI (think English ASA) will soon be sending out guidelines for addressing LA toxicity that includes lipidrescue resuscitation. The authors respond to the letter, pointing out that it's regrettable we haven't done the same in the US and I agree whole heartedly. Its time for a consensus panel to convene and decide on a white paper that provides guidelines and a 'how to' for this situation....along the lines of the difficult airway algorithm. Thanks to all the authors of the survey, the letters and the reply for helping get the word out.

Guy

I am pleased to note the publication of the fourth case report of a save using lipid emulsion infusion. The authors are from Nottingham and the article, published in Anaesthesia (see link below) reports of the successful early intervention with LipidRescue to avert cardiovascular collapse in a patient already showing CNS symptoms of toxicity and early cardiovascular compromise. This is a very well-written case report that is novel in that is illustrates the apparent potential advantage of early treatment in staving off progression to more severe toxicity.

Reference:

G. Foxall, R. McCahon,J. Lamb,3 J. G. Hardman and N. M. Bedforth. Levobupivacaine-induced seizures and cardiovascular collapse treated with Intralipid. Anaesthesia, 2007: 62: 516–518

Please see that we now have postings of the suggested treatment guidelines into 10-11 languages (depending on whether English and American are considered the same). Our latest addition is Mandarin and I'd like to request that any of our readers who are competent in Japanese please submit a translation as well. Bulgarian is also on the way. 

This year's ASRA was a smashing success. More than 1000 registered participants and a slew of well-attended, highly informative lectures, presentations, discussions, posters, and workshops. Congratulations to the ASRA leadership and especially Dr. Tim Brennan for putting together such a great program. The session on local anesthetic properties turned out very well. One couldn't hope for better speakers in the opening component: Drs. John Rowlingson, Marcel Durieux, and John Butterworth each hit near perfect notes in the balance of science and clinical content. The clinical relevance of each talk was much appreciated by the attentive audience. I was pleased to see that the show of hands in response to my question, "Who is stocking lipid in their ORs?" was...... nearly everyone. This may represent another case of self-selection for attending this lecture, but it probably also points to growing acceptance of LipidRescue by the RA community. I would guess that last year, based particularly on Corcoran et al, the prevalence would've been no more than 25%. We've come quite a ways in a short time.

We  can benefit from the significant number of cases now posted on LipidRescue.org. These include several cases that are worthy of publication but fortunately for us, were posted here first. Meantime, it's incumbant on all regional anesthesia practitioners to review and learn from these cases. NONE of them is typical and therefore they are ALL highly instructive. Of course, it is gratifying to see that lipid has benefitted each of these cases. Though I'm not aware of any overt failures, I'm  sure we'll soon begin to hear of cases where it has not been so effective - that (not the outcome...the dissemination) is good. We want to know as much as possible about the limits and effects (good and bad) of any treatment modality. So, if you are aware of a lipid failure, please let us know.

Guy