K Nouette-Gaulain1, X Capdevila2, F Robin3, H Beloeil4. 1. Laboratoire maladies rares : génétique et métabolisme (MRGM), université Segalen Bordeaux 2, 33076 Bordeaux, France; Pôle d'anesthésie-réanimation, centre François Xavier-Michelet, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France. Electronic address: karine.nouette-gaulain@chu-bordeaux.fr. 2. Inserm U1046, département d'anesthésie-réanimation, hôpital Lapeyronie, CHU de Montpellier, bâtiment Inserm Crastes de Paulet, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Pôle d'anesthésie-réanimation samu urgences, université Rennes 1, UMR 991, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France. 3. Laboratoire maladies rares : génétique et métabolisme (MRGM), université Segalen Bordeaux 2, 33076 Bordeaux, France. 4. Pôle d'anesthésie-réanimation samu urgences, université Rennes 1, UMR 991, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
Abstract
OBJECTIVES: Intravenous lipid emulsions (ILE) are recommended today in cases of local anesthetic-induced systemic toxicity (LAST). The objectives of this review consists in describing mechanisms involved in the interaction between ILE and local anesthetic (LA) factors influencing this interaction and the limits associated with the use of ILE. DATA SOURCES: References were obtained from Pubmed data bank (http://www.ncbi.nlm.nih.gov/pubmed) using the following keywords: Intralipid(®), local anesthetic, toxicity, intravenous lipid emulsion. DATA SYNTHESIS: Effects of the association between ILE-LA are based on droplet formations as well as changes in cell metabolism involving survival cell pathway, on functional properties and on direct hemodynamic parameters. Hypoxia, acidosis and high doses of epinephrine modified the effects of ILE-LA association. CONCLUSION: Prescription of ILE is recommended by published guidelines on LAST resuscitation. ILE cannot substitute to the standard resuscitation protocol. It should be added to that protocol. Experimental studies as well as a case report registry will allow understanding further the effects induced by the ILE-LA association.
OBJECTIVES: Intravenous lipid emulsions (ILE) are recommended today in cases of local anesthetic-induced systemic toxicity (LAST). The objectives of this review consists in describing mechanisms involved in the interaction between ILE and local anesthetic (LA) factors influencing this interaction and the limits associated with the use of ILE. DATA SOURCES: References were obtained from Pubmed data bank (http://www.ncbi.nlm.nih.gov/pubmed) using the following keywords: Intralipid(®), local anesthetic, toxicity, intravenous lipid emulsion. DATA SYNTHESIS: Effects of the association between ILE-LA are based on droplet formations as well as changes in cell metabolism involving survival cell pathway, on functional properties and on direct hemodynamic parameters. Hypoxia, acidosis and high doses of epinephrine modified the effects of ILE-LA association. CONCLUSION: Prescription of ILE is recommended by published guidelines on LAST resuscitation. ILE cannot substitute to the standard resuscitation protocol. It should be added to that protocol. Experimental studies as well as a case report registry will allow understanding further the effects induced by the ILE-LA association.