Current evidence supports use of lipid rescue therapy in local anaesthetic systemic toxicity.

Readers may be surprised by the recent editorial of Dr. Rosenberg, ‘Current evidence is not in support of lipid rescue therapy in local anaesthetic systemic toxicity’. Lipid rescue therapy (LRT) is widely accepted and recommended for treating local anaesthetic systemic toxicity (LAST) but Dr. Rosenberg purports that the efficacy and safety data are insufficient to warrant its use for this indication. I share his strong preference for evidence-based medicine, including LRT, and the belief that skepticism is a necessary element of applying science to medical practice. However, in reviewing virtually the same clinical and experimental data I draw the opposite conclusion. LRT clearly saves lives and evidence for its efficacy, safety, and mechanism of action are strongest for treatment of LAST. Dr. Rosenberg’s arguments fall into three key domains.