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http://www.rxmed.com Intralipid
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* 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.
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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
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*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.concentrationscompoundimmisciblesolvents equilibrium
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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
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*Preliminary study: Induced Cardiac arrest in 3 dogs with bupivacaine all immediately rescuscitated with Intralipid
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All 6 dogs in treatment group survived with ROSC within 30 minutes. None in control group did
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http://www.anl.gov/Media_Center/ArgonneNow/Fall_2007/images/kaletra- hirez.jpg
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Journal of Toxicology: Clinical Toxicology v36.n6 (Oct 1998): pp 595 (4).
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QRS 200msec! Few minutes later...
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Happy ever after
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*Boehnert. NEJM 1985; Liebelt. Ann Emerg Med 1995
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Results:
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MAP & SVRI
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HR & CO
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ABG’s
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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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