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

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

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

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

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

47. QRS 200msec! Few minutes later...

49. Happy ever after

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

65. Results:

73. MAP & SVRI

74. HR & CO

75. ABG’s

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.

80. QUESTIONS?