Lipid resuscitation in acute poisoning: after a decade of

Curr Opin Anaesthesiol · Aug 2017

Lipid resuscitation in acute poisoning: after a decade of publications, what have we really learned?

The decision to provide intravenous lipid emulsion (ILE) therapy as a treatment modality for the reversal of various drug toxicity was discovered in the last decade. Numerous publications, in both humans and animals attest to its clinical use, but current supporting evidence is inconsistent. ⋯ ILE can be used to resuscitate local anesthetics especially bupivacaine. The impact of ILE on oral overdoses is controversial and clear evidence on benefit is lacking. A thorough risk benefit assessment with consideration of alternative options is warranted to minimize the risk of adverse effects. Evidence supports using bolus doses of ILE, while infusion rates are still debatable.

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- aCopenhagen University Hospital Bispebjerg, Department of Anaesthesiology and the Danish Poisons Information Center Bispebjerg Bakke 23, Copenhagen, Denmark bMcGill University Health Centre, Medicine & Emergency Medicine, Royal Victoria Hospital, Montréal, Quebec, Canada.
- Curr Opin Anaesthesiol. 2017 Aug 1; 30 (4): 474-479.
Purpose Of ReviewThe decision to provide intravenous lipid emulsion (ILE) therapy as a treatment modality for the reversal of various drug toxicity was discovered in the last decade. Numerous publications, in both humans and animals attest to its clinical use, but current supporting evidence is inconsistent.Recent FindingsA recent systematic review reported evidence for benefit of ILE in bupivacaine toxicity. Human randomized trials, large observational studies as well as animal models of orogastric poisoning failed to report a clear benefit of ILE for nonlocal anesthetics poisoning.SummaryILE can be used to resuscitate local anesthetics especially bupivacaine. The impact of ILE on oral overdoses is controversial and clear evidence on benefit is lacking. A thorough risk benefit assessment with consideration of alternative options is warranted to minimize the risk of adverse effects. Evidence supports using bolus doses of ILE, while infusion rates are still debatable.

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Lipid resuscitation in acute poisoning: after a decade of publications, what have we really learned?

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