Download - Intralipid
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Intralipid
* Pts with carnitine deficiency get arrhythmias with bupivacaine. Carnitine essential for cardiac energy. Lipids accumulate in the myocytes in ischemia. So if Bupivacaine worsens already poor cardiac fatty-acid metabolism adding lipids should make it even worse.
Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998 Apr;88(4):1071-5
Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998 Apr;88(4):1071-5
Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998 Apr;88(4):1071-5
Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998 Apr;88(4):1071-5
*partition (P) or distribution coefficient (D) is the ratio of concentrations of a compound in the two phases of a mixture of two immiscible solvents at equilibrium.
Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998 Apr;88(4):1071-5
*Preliminary study:Induced Cardiac arrest in 3 dogs with bupivacaine all immediately rescuscitated with Intralipid
•All 6 dogs in treatment group survived with ROSC within 30 minutes.
•None in control group did
http://www.anl.gov/Media_Center/ArgonneNow/Fall_2007/images/kaletra-hirez.jpg
Journal of Toxicology: Clinical Toxicology v36.n6 (Oct 1998): pp 595 (4).
QRS 200msec!
Few minutes later ...
Happy ever after
*Boehnert. NEJM 1985; Liebelt. Ann Emerg Med 1995
Results:
MAP & SVRI
HR & CO
ABG’s
•Rats pretreated with either Lipid or 0.9% NS then given constant infusion of propranolol until death. •Measured ECG q 2 min until death.RESULTS:
•No signif difference in lethal dose of propranolol.•The percent change in QRS duration was reduced (from -0.9 to 17.3, p=0.016) in the Lipid group. •“Trend” of Less bradycardia observed in the lipid (p=0.06).
•Authors suggest that lipid emulsion may be effective in ameliorating propranolol toxicity in rats.
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