http://www.rxmed.com

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.

QUESTIONS?