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Intralipid.

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Presentation on theme: "Intralipid."— Presentation transcript:

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16 http://www.rxmed.com Intralipid

17 * 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.

18 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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21 *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

22 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

23 *Preliminary study: Induced Cardiac arrest in 3 dogs with bupivacaine  all immediately rescuscitated with Intralipid

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25 All 6 dogs in treatment group survived with ROSC within 30 minutes. None in control group did

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30 http://www.anl.gov/Media_Center/ArgonneNow/Fall_2007/images/kaletra- hirez.jpg

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43 Journal of Toxicology: Clinical Toxicology v36.n6 (Oct 1998): pp 595 (4).

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47 QRS 200msec! Few minutes later...

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49 Happy ever after

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53 *Boehnert. NEJM 1985; Liebelt. Ann Emerg Med 1995

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65 Results:

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73 MAP & SVRI

74 HR & CO

75 ABG’s

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78 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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80 QUESTIONS?

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