Lipid resuscitation for local anesthetic toxicity: is it really lifesaving?

PURPOSE OF REVIEW Laboratory studies and clinical reports have led to the acceptance of lipid emulsion as an effective treatment of local anesthetic-induced cardiac arrest. This review discusses subsequent clinical reports, relevant laboratory studies and topics for further research. RECENT FINDINGS Case reports have confirmed the efficacy of lipid resuscitation for local anesthetic systemic toxicity. Furthermore, lipid emulsion has been used with apparent success early in the spectrum of local anesthetic systemic toxicity to preempt cardiac arrest. The role of lipid emulsion has expanded to treatment of cardiac toxicity due to other lipophilic drugs. This appears to have an acceptable safety profile, although elevated amylase has been reported. Laboratory investigations in animals suggest that concomitant hypoxemia hinders resuscitation attempts, and that epinephrine and vasopressin are more likely to be associated with poor outcomes than lipid. SUMMARY Lipid emulsion infusion appears to be an effective treatment for cardiac toxicity induced by lipophilic medications. Given the difficulties of performing clinical trials, further laboratory investigation and clinical correlation are needed to better define its role in resuscitation.