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Feb112010

Recommendations for LipidRescue Rescusitation

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 (2)

Hi,

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.
September 16, 2014 | Unregistered CommenterJason C Swanson RN
Glad everything worked out, Jason. Can you provide a bit more information for educational purposes: patients age, weight, co-morbidities. What was the timing of the event in terms of the block; what was the dominant cardiac rhythm during the arrest ?
Thanks,
Guy
October 3, 2014 | Registered Commenter[Guy Weinberg]

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