Guidelines: Lipid Therapy and Local Anesthetic Toxicity

Dr. Lee

Lipid Emulsion Infusion Resuscitation for Local Anesthetic and Other Drug Overdose

Anesthesiology: July 2012 - Volume 117 - Issue 1 - p 180–187

Lipid emulsion therapy is a known antidote for local anesthetic toxicity, but the guidelines for it’s use, it’s mechanism of action, and it’s application beyond local anesthetic toxicity continue to be discussed.  The article listed above provides some practical insight into these issues.

The article lists several websites that differ in their guidelines for lipid emulsion therapy, but generally have an accepted approach.  In the context of local anesthetic toxicity, optimizing oxygenation and ventilation through airway management comes first, then seizure suppression where applicable, then lipid emulsion therapy.  Effective BLS and ACLS are vital as well.  The dosing of lipid emulsion should be 20% lipid emulsion 1.5mg/kg IV Bolus followed by 0.25-0.5ml/kg/min infusion for 10 minutes following recovery of vital signs.