HERE'S WHAT'S NEW IN LIPIDRESCUE!
September 2009
Hiller et al, garnishes the cover of Anesthesiology and an editorial by Cave and Martyn. This paper shows by dose-response that a single dose of epinephrine above a certain threshold (~10mcg/kg) given along with lipid infusion profoundly inhibits successful recovery from bupivacaine overdose (20mg/kg) compared with lipid alone. The potential clinical implication is that higher dose epinephrine is potentially harmful to patients with drug-induced cardiac arrest.
August 2009
Shah et al publish in J Anesth the first case report of successful lipidrescue in an infant!
July 2009
Cave et al show in a paper published in Anaesthesia that the standard protocol for lipidrescue published by the AAGBI is effective in a a rabbit model of bupivacaine overdose.
Dr. Ulana Leskiw and I publish a review of lipidrescue in Current Opinions in Anaesthesiology.
Hicks et al publish in Anesthesiology a paper showing that lipid rescue is not effective when combined with epinephrine and vasopressin in treating a porcine model of bupivacaine-induced cardiac arrest.
May 2009
The current issue of Regional Anesthesia and Pain Medicine has FOUR case reports of successful lipidrescue in the letters-to-the-editor plus an editorial by Dr. Butterworth on the overall importance of case reports to our practice of medicine. One of the most impressive cases (Markowitz and Neal) involves a patient successfully treated with lipid alone and no epinephrine.
Another first! Young et al published in Resuscitation the first case report of successful lipidrescue from verapamil toxicity, (nb, this is a classical calcium channel blocker used in treating hypertension).
April 2009.
Two papers and an editorial in Anesthesia and Analgesia address lipid rescue. One paper by Harvey et al shows that lipid infusion may be deliterious in the setting of asphyxial arrest. Another by Marwick et al reports a patient that had recurrent cardiac arrest long after an initial, successful lipid rescue. My editorial focuses on limitations of our knowledge of lipidrescue.
My first paper in a veterinary journal was publisehd this month. My co-author Dr. Dawn Crandell and I report in J Vet Emerg Crit Care a successful lipidrescue from severe neurological depression in a puppy caused by overwhelming moxidectin overdose (this is a parasiticide).
March 2009.
Cave and Harvey published a paper in Anaesthesia showing potential efficacy of lipid in treating beta blocker toxicity in rabbits.
February 2009 - A busy month at lipidrescue.org
The British Journal, Anaesthesia, official publication of the Association of Anaesthetists of Great Britain and Ireland has three important papers related to LipidRescue in the February 2009 issue. First is medical survey (John Picard, first author) looking at the adoption of lipid emulsion therapy among hospitals in the metro London area. A very nice figure demonstrates the rapid increase in willingness, awareness, or preparedensss to use lipid therapy. More than 80% of facilities are now prepared to use lipid emulsion. Second is a case report by Uncles et al of a patient in deep coma following an overdose of quetiapine and sertraline and its reversal by LipidRescue. The patient avoided intubation and a stay in the intensive care unit following infusion of lipid emulsion as he rapidly became conscious. Finally, is an eloquent editorial by Drs. Picard and Harrop-Griffiths reflecting on the history of LipidRescue, focusing on the contribution of AAGBI to the spread of LipidRescue in the UK. You can get links to the PubMed citations for these articles at the Literature Link in the navigation bar.
Thanks to Dr. van Dusseldorp of Amsterdam for sending us the Dutch version of the instructions, now posted.
An excellent editorial on lipid resuscitation in the March 2009 Critical Care Medicine was made available on-line today. Dr. Jeffrey Brent offered an excellent, cogent and concise summary of the state-of-the-Art. The accompanying paper was co-authored by Dr. Di Gregorio and me and compares lipid-alone versus vasopressin +/- epinephrine in a rat model of bupivacaine-induced asystole. Vasopressin appears to reproducibly worsen all metrics of outcome in this setting. I think further study is needed but if these results hold, they could eventually show that perhaps vasopressin should be contraindicated for LA toxicity.
A paper published this month in Anesthesiology by Mazoit et al shows that standard lipid emulsions used in lipidrescue bind very large amounts of local anesthetics. Interestingly, they show that low pH impairs this binding.
January 2009; Polish on board now. First post of save from calcium channel blocker toxicity.
Thanks to Dr. Andrzej Daszkiewicz we now have the long awaited Polish version of the LipidResuce instructions suitable for lamination. Thanks Andrzej! Does anyone know someone who could provide a Japanese version?
Dr. Bo Gottschau reports here at the 'Post Your Cases' page the first apparent successful LipidRescue resuscitation from an overwhelming calcium channel overdose. There are good laboratory studies showing efficacy in dog models, but this is the first example in a human. Note the similarities with the case reported by Sirianni of bupropion overdose, including the severe pulmonary edema which I ascribe to aggressive use of adrenergics. This case was particularly impressive since theICU team was prepared to end the code before the anesthesiologist (Dr. G) recommended lipid infusion.Alright Bo....now write it up.