Corman Shelby L, Skledar Susan J
Drug Information Center, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Ann Pharmacother. 2007 Nov;41(11):1873-7. doi: 10.1345/aph.1K244. Epub 2007 Sep 25.
To evaluate the use of lipid emulsion for reversal of local anesthetic-induced toxicity.
Literature was accessed through PubMed and OVID (1966-May 2007) using the search terms lipid emulsion and local anesthetic. Reference lists were consulted to identify additional publications.
All articles published in English were evaluated for inclusion. Publications describing the use of lipid emulsion for reversal of local anesthetic in either humans or animals were included.
It has been suggested that lipid emulsion (Intralipid) may reverse local anesthetic toxicity by extracting lipophilic local anesthetics from aqueous plasma or tissues or by counteracting local anesthetic inhibition of myocardial fatty acid oxygenation. Studies in rats and dogs have shown that lipid emulsion is effective in resuscitating animals who are asystolic after the administration of intravenous bupivacaine. Three case reports support the use of lipid emulsion to reverse systemic toxicity, including seizures, electrocardiogram abnormalities, and cardiac arrest, resulting from the administration of levobupivacaine, ropivacaine, bupivacaine, or mepivacaine. The regimens used in these cases consisted of bolus doses of 1.2-2 mL/kg followed by continuous infusions of 0.25-0.5 mL/kg/min. All of the patients recovered fully with no neurologic sequelae.
Literature describing animal studies and human case reports suggests that lipid emulsion is effective in the reversal of local anesthetic toxicity. The potential risks of administering the relatively high doses of this agent are uncertain, and the optimal dose has not been established. In light of these uncertainties, it is appropriate to administer lipid emulsion only after advanced cardiac life support has failed and prior to cardiopulmonary bypass.
评估脂质乳剂用于逆转局部麻醉药所致毒性的效果。
通过PubMed和OVID（1966年至2007年5月）检索文献，检索词为脂质乳剂和局部麻醉药。查阅参考文献列表以识别其他出版物。
评估所有英文发表的文章是否纳入。纳入描述脂质乳剂用于逆转人类或动物局部麻醉药毒性的出版物。
有人提出脂质乳剂（英脱利匹特）可能通过从血浆或组织中提取亲脂性局部麻醉药或通过抵消局部麻醉药对心肌脂肪酸氧化的抑制作用来逆转局部麻醉药毒性。对大鼠和狗的研究表明，脂质乳剂对静脉注射布比卡因后出现心搏停止的动物复苏有效。3例病例报告支持使用脂质乳剂逆转由左旋布比卡因、罗哌卡因、布比卡因或甲哌卡因给药引起的全身毒性，包括癫痫发作、心电图异常和心脏骤停。这些病例中使用的方案包括1.2 - 2 mL/kg的推注剂量，随后以0.25 - 0.5 mL/kg/分钟的速度持续输注。所有患者均完全康复，无神经后遗症。
描述动物研究和人类病例报告的文献表明，脂质乳剂对逆转局部麻醉药毒性有效。给予相对高剂量该药物的潜在风险尚不确定，且最佳剂量尚未确定。鉴于这些不确定性，仅在高级心脏生命支持失败后且在体外循环之前给予脂质乳剂才是合适的。
