Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review
Currently, lipid emulsion (LE) is widely used to treat local anesthetic systemic toxicity (LAST). LE also ameliorates intractable cardiovascular collapse caused by lipid-soluble non-local anesthetic drug toxicity. This review aims to provide the underlying mechanism of LE resuscitation in drug toxic...
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2023-06-01
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| Series: | Korean Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://ekja.org/upload/pdf/kja-23031.pdf |
| _version_ | 1797815418305380352 |
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| author | Soo Hee Lee Ju-Tae Sohn |
| author_facet | Soo Hee Lee Ju-Tae Sohn |
| author_sort | Soo Hee Lee |
| collection | DOAJ |
| description | Currently, lipid emulsion (LE) is widely used to treat local anesthetic systemic toxicity (LAST). LE also ameliorates intractable cardiovascular collapse caused by lipid-soluble non-local anesthetic drug toxicity. This review aims to provide the underlying mechanism of LE resuscitation in drug toxicity (including LAST) and a detailed description of LE treatment and to discuss further research directions. We searched for relevant articles using the following keywords: “local anesthetic systemic toxicity or LAST or toxicity or intoxication or poisoning” and “Intralipid or lipid emulsion.” The underlying mechanisms of LE treatment can be classified into indirect and direct effects. One indirect effect known as the lipid shuttle is a commonly accepted mechanism of LE treatment. The lipid shuttle involves the absorption of highly lipid-soluble drugs (e.g., bupivacaine) from the heart and brain through the lipid phase, which are then delivered to the muscle, adipose tissue, and liver for storage and detoxification. The direct effects include inotropic effects, fatty acid supply, attenuation of mitochondrial dysfunction, glycogen synthase kinase-3β phosphorylation, and inhibition of nitric oxide. These mechanisms appear to act synergistically to treat drug toxicity. The recommended protocol for LE treatment of LAST is as follows: a bolus administration of 20% LE at 1.5 ml/kg over 2–3 min followed by 20% LE at 0.25 ml/kg/min. LAST most commonly occurs after intravenous administration of local anesthetics. However, non-local anesthetic drugs that cause drug toxicity are orally administered. Further studies are needed to determine the optimal dosing schedule of LE treatment for non-local anesthetic drug toxicity. |
| first_indexed | 2024-03-13T08:22:23Z |
| format | Article |
| id | doaj.art-23af558bdbef4d39981780643df08bb4 |
| institution | Directory Open Access Journal |
| issn | 2005-6419 2005-7563 |
| language | English |
| last_indexed | 2024-03-13T08:22:23Z |
| publishDate | 2023-06-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj.art-23af558bdbef4d39981780643df08bb42023-05-31T05:42:11ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632023-06-0176317118210.4097/kja.230318878Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative reviewSoo Hee Lee0Ju-Tae Sohn1 Department of Anesthesiology and Pain Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea Institute of Health Sciences, Gyeongsang National University, Jinju, KoreaCurrently, lipid emulsion (LE) is widely used to treat local anesthetic systemic toxicity (LAST). LE also ameliorates intractable cardiovascular collapse caused by lipid-soluble non-local anesthetic drug toxicity. This review aims to provide the underlying mechanism of LE resuscitation in drug toxicity (including LAST) and a detailed description of LE treatment and to discuss further research directions. We searched for relevant articles using the following keywords: “local anesthetic systemic toxicity or LAST or toxicity or intoxication or poisoning” and “Intralipid or lipid emulsion.” The underlying mechanisms of LE treatment can be classified into indirect and direct effects. One indirect effect known as the lipid shuttle is a commonly accepted mechanism of LE treatment. The lipid shuttle involves the absorption of highly lipid-soluble drugs (e.g., bupivacaine) from the heart and brain through the lipid phase, which are then delivered to the muscle, adipose tissue, and liver for storage and detoxification. The direct effects include inotropic effects, fatty acid supply, attenuation of mitochondrial dysfunction, glycogen synthase kinase-3β phosphorylation, and inhibition of nitric oxide. These mechanisms appear to act synergistically to treat drug toxicity. The recommended protocol for LE treatment of LAST is as follows: a bolus administration of 20% LE at 1.5 ml/kg over 2–3 min followed by 20% LE at 0.25 ml/kg/min. LAST most commonly occurs after intravenous administration of local anesthetics. However, non-local anesthetic drugs that cause drug toxicity are orally administered. Further studies are needed to determine the optimal dosing schedule of LE treatment for non-local anesthetic drug toxicity.http://ekja.org/upload/pdf/kja-23031.pdfdrugintravenous fat emulsionslocal anestheticspoisoningtherapeuticstoxicity |
| spellingShingle | Soo Hee Lee Ju-Tae Sohn Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review Korean Journal of Anesthesiology drug intravenous fat emulsions local anesthetics poisoning therapeutics toxicity |
| title | Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review |
| title_full | Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review |
| title_fullStr | Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review |
| title_full_unstemmed | Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review |
| title_short | Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review |
| title_sort | mechanisms underlying lipid emulsion resuscitation for drug toxicity a narrative review |
| topic | drug intravenous fat emulsions local anesthetics poisoning therapeutics toxicity |
| url | http://ekja.org/upload/pdf/kja-23031.pdf |
| work_keys_str_mv | AT sooheelee mechanismsunderlyinglipidemulsionresuscitationfordrugtoxicityanarrativereview AT jutaesohn mechanismsunderlyinglipidemulsionresuscitationfordrugtoxicityanarrativereview |