The first case report of successful resuscitation of a patient in prolonged cardiac arrest from presumed systemic local anesthetic toxicity. The patient recovered with no neurological sequelae after ~20 minutes of asystole and no response to ACLS. <s

The second case report of lipid emulsion infusion successfully resuscitating a patient from apparently intractable cardiac arrest. This case involved ropivacaine.

This is a chance to test your German. A very interesting case of toxicity presenting as agitation and SVT. They used clonidine first, then lidocaine, then propofol without success. All symptoms resolved after lipid infusion. Only one case but instructive.

See the Blog and News of 9-13-07. This is an absolutely amazing case.

This may be the first example of purely CNS symptoms reversed by lipidrescue. Very well written case report as letter to the editor with good commentary.

A nice case report of patient with seizures and ventricular tachycardia responding to lipid + countershock. Patient did well.

A fascinating case that illustrates the value in educating physicians in LipidRescue methodology. A training session resulted in a clean save several months later.

An impressive save with lipid. Good ECG traces.

Another great save with a very thought provoking discussion.

The first report of LIpidRescue in a child.

Excellent case report of lipid reversing CNS and cardiovascular signs of toxicity.

A very interesting case of reversing deep coma with lipidrescue. Saved the pt intubation and a night in the ICU.

This is a very interesting comment, pointing out the similarities in terms of progress in acceptance of lipid for local anesthetic toxicity and dantrolene for MH.

My editorial on the current state-of-the-art.

Excellent editorial on LipidRescue method.

An editorial by my mentor, John Rowlingson.

Studies in a dog model of acute bupivacaine toxicity find that all subjects treated with lipid exhibit return of normal hemodynamics while no controls recover.

This paper reports the original observation in rats that lipid prevents (pretreatment) and treats bupivacaine overdose.

This study shows that lipid infusion rescues rabbits given an overdose of clomipramine. Very similar to the dog bupivacaine studies, no animals given bicarb survived; all lipid-treated animals did (n=4 in each group).

A excellent paper, the authors performed a survey of academic US anesthesiology depts on their preparation for local anesthetic systemic toxicity. They show a lack of general agreement on an approach to treating LA toxicity.

A study in dogs shows that lipid infusion resuced subjects from high dose verapamil. In one limb, 14% survival in controls compared with 100% survival in the treated group. We hope this study will increase awareness of lipid rescue among toxicologists.

Epinephrine is shown in a rodent model of bupivacaine overdose to have adverse effects on hemodynamics and metabolic profile c/w lipid.

These studies find the optimal dose of 20% lipid emulsion for resuscitating rats in verapimil overdose was 18mL/kg. Interestingly, we've found the optimal dose of 30% lipid emulsion for bupivacaine overdose is 12 mL/kg: exactly the same mass of lipid!

A survey of general awareness among an Australian medical community of lipid rescue.

A survey investigating the rate of adoption of AAGBI guidelines in the UK.

A survey of obstetric departments in the UK

This paper reports that bupivacaine protects the heart against the tissue acidosis in 'no flow' states. This might explain successful lipid resuscitation in animals and case reports after long 'downtimes'.

Ironically, bupivacaine is a good cardioprotectant. This suggests that bupivacaine toxicity should be entirely reversible, with no permanent cardiac damage.

A summary of state-of-the-art as of December 2006. Includes lab background, some mechanism data and information on the first two cases. And you can buy it on the Ingentaconnect site for only $54.

A review of this promising approach to myocardial preservation.

A very nice review of lipid emulsion therapy...in French

Bupivacaine inhibits mitochondrial transport of the heart's preferred fuel.

This study in isolated heart indicates that hearts using lipid substrate are more sensitive to bupivacaine toxicity than those burning carbohydrate.

This is the index case for my interest in local anesthetic toxicity. This event led indirectly to the discovery of an antidote for this life-threatening condition.

A letter in reply to a study showing that insulin-glucose attenuates bupivacaine toxicity. We provide an alternate explanation.

Experiments supporting my theory that interaction with cardiolipin can explain bupivacaine's metabolic affects.