Recommendations for LipidRescue Rescusitation
Thursday, February 11, 2010 at 12:07PM These suggestions were originally designed for treatment of local anesthetic systemic toxicity, LAST, but could theoretically apply with appropriate modifications to treating any lipophilic drug overdose. Formal guidelines for treating LAST can be found at this ASRA site.
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Initial Focus
- Airway management: ventilate with 100% oxygen
- Seizure suppression: benzodiazepines are preferred
- Basic and Advanced Cardiac Life Support (BLS/ACLS) may require prolonged effort
Infuse 20% Lipid Emulsion (values in parenthesis are for a 70 kg patient)
- Bolus 1.5 mL/kg (lean body mass) intravenously over 1 min (~100 mL)
- Continuous infusion at 0.25 mL/kg/min (~18 mL/min; adjust by roller clamp)
- Repeat bolus once or twice for persistent cardiovascular collapse
- Double the infusion rate to 0.5 mL/kg per minute if blood pressure remains low
- Continue infusion for at least 10 mins after attaining circulatory stability
- Recommended upper limit: approximately 10-12 mL/kg lipid emulsion over the first 30 mins
Avoid vasopressin, calcium channel blockers, β-blockers, or local anesthetic
Avoid high dose epinephrine; preferrably use doses < 1 mcg/kg
Alert the nearest facility having cardiopulmonary bypass capability (esp for local anesthetic toxicity)
Avoid propofol in patients with cardiovascular instability
Post LAST events at www.lipidrescue.org and report use of lipid to www.lipidregistry.org
Reader Comments (3)
Recently we treated a patient who had develeoped a toxic reaction to ropivicaine use in an ankle block. She lost consciousness, seized, and arrested. We managed the situation and administered 20% intralipids in addition to ACLS. She made a full recovery within 15 minutes. It was the lipids that had the greatest effect, and made the other inteventions successful.
Thank You.
Thanks,
Guy