Post Your Cases > Are there any cases where intralipid was used without success?
Hi Dr. Martinek,
There will unquestionably be failed resuscitations that included lipid infusion; whether those are true failures of the lipid will be difficult to ascertain. Certainly, patient factors (severe, underlying cardiac disease or other co-morbidities), or treatment factors (delayed recognition of toxicity or intervention, insufficient oxygenation or ventilation during resuscitation), could impair recovery.
As you point out, not all the laboratory models have good outcomes with liipd infusion, but I would caution you that some of these experimental systems add confounders (like hypoxia, delayed treatment, or high dose adrenergic therapy) that are known to adversely affect local anesthetic toxicity. If lipid doesn't work, I wouold argue that's because the models don't offer a clear test of efficacy of lipid on local anesthetic overdose alone.
I will encourage people to share their 'lipid failures' for the educational value we can glean from such cases. But I am not optimistic that people will want to write about these cases.
Guy
There will unquestionably be failed resuscitations that included lipid infusion; whether those are true failures of the lipid will be difficult to ascertain. Certainly, patient factors (severe, underlying cardiac disease or other co-morbidities), or treatment factors (delayed recognition of toxicity or intervention, insufficient oxygenation or ventilation during resuscitation), could impair recovery.
As you point out, not all the laboratory models have good outcomes with liipd infusion, but I would caution you that some of these experimental systems add confounders (like hypoxia, delayed treatment, or high dose adrenergic therapy) that are known to adversely affect local anesthetic toxicity. If lipid doesn't work, I wouold argue that's because the models don't offer a clear test of efficacy of lipid on local anesthetic overdose alone.
I will encourage people to share their 'lipid failures' for the educational value we can glean from such cases. But I am not optimistic that people will want to write about these cases.
Guy
November 7, 2008 |
[Guy Weinberg]
[Guy Weinberg]
The question of whether 'failure' rate is captured at this site or anywhere was brought up at our last anesthesia journal club meeting. Will it be possible to create a data base at this site where all cases that lipid is used as an antidote be recorded? This may help to give a better picture in terms of efficacy, adverse effects and so on.....
RC
RC
December 4, 2008 |
Rita Chan (pharmacist)
Rita Chan (pharmacist)
hi rita,
see the note directly above yours. i would love to create a true registry where all cases of presumed LA toxicity are reported whether or not lipid is used and whether or not it is successful. but there's really no incentive for people to report their negative results. there's also apparently decreasing incentive for reporting the positive lipid results as I frequently encounter anesthesiologists who tell me it was used successfully in their department over the past year (some more than once) and they chose not to publish or even submit here.
the other problem with failures is that we'll rarely know why a patient didn't recover: severe underlying dilated or ischemic cardiomyopathy, other cardiac morbidities, asphyxia, acidosis, excess epinephrine (see my paper in Anesthesiology earlier this year), bad chest compressions (the list goes on) , or...true lipid failure. it will generally be very difficult to sort all of this out. nevertheless, let me emphasize, i'd love to hear about all cases of LA toxicity. we'll all benefit from the shared, vicarious experience and knowledge contained in such reports.
guy
see the note directly above yours. i would love to create a true registry where all cases of presumed LA toxicity are reported whether or not lipid is used and whether or not it is successful. but there's really no incentive for people to report their negative results. there's also apparently decreasing incentive for reporting the positive lipid results as I frequently encounter anesthesiologists who tell me it was used successfully in their department over the past year (some more than once) and they chose not to publish or even submit here.
the other problem with failures is that we'll rarely know why a patient didn't recover: severe underlying dilated or ischemic cardiomyopathy, other cardiac morbidities, asphyxia, acidosis, excess epinephrine (see my paper in Anesthesiology earlier this year), bad chest compressions (the list goes on) , or...true lipid failure. it will generally be very difficult to sort all of this out. nevertheless, let me emphasize, i'd love to hear about all cases of LA toxicity. we'll all benefit from the shared, vicarious experience and knowledge contained in such reports.
guy
December 4, 2008 |
[Guy Weinberg]
[Guy Weinberg]
However I was wondering if there have been any cases where lipid was used for suspected LA toxicity where it did not (seem to) work.
There have been some small animal studies that contradict the background studies and positive experiences posted on this site.
Any anecdotal human cases out there where lipid did not work?
RM