LipidRescue™ Resuscitation

A 70 yo female with history of hypertension, non insulin dependent type II DM, CAD treated with PTCA drug eluting stent in January 2013, hysterectomy and thyrodectomy for basedow disease.

She was planned to undergo to vitrectomy in locoregional anesthesia. When patient was monitored her vital signs were SpO2 100 % in room air oxygen, NIBP 158/76 mmHg, HR 70 bpm rhythmic and RR 15. Retrobulbar block was performed by surgeon with a mixture of 5 ml ropivacaine 1% and 5 ml mepivacaine 1%. Two minutes after the block patient developed synus tachycardia with HR 113 bpm and severe hypertension with NIBP 224/113 mmHg, referring headache and dizziness. HTN was treated with urapidil 15 mg that dropped BP to 160/74. Five minutes after the block patient become unresponsive with GCS 3 and apnoic with respiratory arrest. Her HR was 85 bpm, BP 155/70 mmHg. She was promptly intubated and she started mechanical ventilation. Considering local anesthetic systemic toxicity (LAST) due to intravascular injection or perineural diffusion in the brain intralipid bolus 1.5 mL*kg-1 of total body weight (TBW) was administered followed by an infusion of 0.25 mL*kg-1*min-1 of TBW. Transfer to ICU was planned and 20 minutes (50 after the block) after the admission patient recovered a fully neurological status without any deficits and promptly extubated. No sedation was performed during all the period. Intralipid infusion was interrupted after the extubation and patient was monitored for the next 12 hours and then discharged to the regular ward.
We don't know the real mechanism of the LAST but intralipid infusion could help in complete neurological recover of the patient.

Thank you Dr. Weinberg for your answer,

I was asking me too why seizure activity or paralysis are not occurred. Do you think that lipid infusion can fast brain stem anesthesia? Do you know which the possible mechanism?

thanks again for your availability

Iacopo Cappellini