Editing Local anesthetic (section)

====Treatment of overdose: "Lipid rescue"====

'''Lipid emulsion therapy''' or '''lipid rescue''' is a method of toxicity treatment was invented by Dr. Guy Weinberg in 1998, and was not widely used until after the first published successful rescue in 2006. Evidence indicates [[Intralipid]], a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anesthetic overdose, including human case reports.<ref name="Weinberg 1998">{{cite journal | vauthors = Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ | title = Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats | journal = Anesthesiology | volume = 88 | issue = 4 | pages = 1071–1075 | date = April 1998 | pmid = 9579517 | doi = 10.1097/00000542-199804000-00028 | s2cid = 1661916 | doi-access = free }}</ref><ref name="Weinberg 2003">{{cite journal | vauthors = Weinberg G, Ripper R, Feinstein DL, Hoffman W | title = Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity | journal = Regional Anesthesia and Pain Medicine | volume = 28 | issue = 3 | pages = 198–202 | year = 2003 | pmid = 12772136 | doi = 10.1053/rapm.2003.50041 | s2cid = 6247454 }}</ref><ref name="Picard2006">{{cite journal | vauthors = Picard J, Meek T | title = Lipid emulsion to treat overdose of local anesthetic: the gift of the glob | journal = Anaesthesia | volume = 61 | issue = 2 | pages = 107–109 | date = February 2006 | pmid = 16430560 | doi = 10.1111/j.1365-2044.2005.04494.x | s2cid = 29843241 }}</ref><ref name="Rosenblatt2006">{{cite journal | vauthors = Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB | title = Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest | journal = Anesthesiology | volume = 105 | issue = 1 | pages = 217–218 | date = July 2006 | pmid = 16810015 | doi = 10.1097/00000542-200607000-00033 | s2cid = 40214528 | doi-access = free }}</ref><ref name="Litz2006">{{cite journal | vauthors = Litz RJ, Popp M, Stehr SN, Koch T | title = Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion | journal = Anaesthesia | volume = 61 | issue = 8 | pages = 800–801 | date = August 2006 | pmid = 16867094 | doi = 10.1111/j.1365-2044.2006.04740.x | s2cid = 43125067 }}</ref> However, the evidence at this point is still limited.<ref>{{cite journal | vauthors = Cave G, Harvey M | title = Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review | journal = Academic Emergency Medicine | volume = 16 | issue = 9 | pages = 815–824 | date = September 2009 | pmid = 19845549 | doi = 10.1111/j.1553-2712.2009.00499.x | doi-access = free }}</ref>

Though most case reports to date have recorded most common use of Intralipid, other emulsions, such as [[Liposyn]] and [[Medialipid]], have also been shown effective.{{citation needed|date=April 2023}}

Ample supporting animal evidence<ref name="Weinberg 1998"/><ref name="Weinberg 2003"/> and human case reports show successful use of lipid rescue in this way.<ref name="Rosenblatt2006"/><ref name="Litz2006"/> In the UK, efforts have been made to publicize lipid rescue more widely.<ref name="Picard2006"/> In 2010, lipid rescue had been officially promoted as a treatment of local anesthetic toxicity by the [[Association of Anaesthetists of Great Britain and Ireland]].<ref>{{Cite web |date=December 2010 |title=Management of severe local anaesthetic toxicity |url=https://anaesthetists.org/Search-Results?search=Local%20anaesthetic%20toxicity |access-date=2023-04-10 |website=anaesthetists.org. [[Association of Anaesthetists of Great Britain and Ireland]] (AAGBI).}}</ref> One published case has been reported of successful treatment of refractory [[cardiac arrest]] in [[bupropion]] and [[lamotrigine]] overdose using lipid emulsion.<ref>{{cite journal | vauthors = Sirianni AJ, Osterhoudt KC, Calello DP, Muller AA, Waterhouse MR, Goodkin MB, Weinberg GL, Henretig FM | display-authors = 6 | title = Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine | journal = Annals of Emergency Medicine | volume = 51 | issue = 4 | pages = 412–5, 415.e1 | date = April 2008 | pmid = 17766009 | doi = 10.1016/j.annemergmed.2007.06.004 }}</ref>

The design of a 'homemade' lipid rescue kit has been described.<ref>{{Cite web |title=lipidrescue - Sample LipidRescue Kit |url=http://lipidrescue.squarespace.com/sample-lipidrescue-kit |url-status=live |archive-url=https://web.archive.org/web/20220725082408/http://lipidrescue.squarespace.com/sample-lipidrescue-kit |archive-date=2022-07-25 |website=lipidrescue.squarespace.com}}</ref>

Although lipid rescue mechanism of action is not completely understood, the added lipid in the blood stream may act as a sink, allowing for the removal of lipophilic toxins from affected tissues. This theory is compatible with two studies on lipid rescue for clomipramine toxicity in rabbits<ref name="Harvey 2007">{{cite journal | vauthors = Harvey M, Cave G | title = Intralipid outperforms sodium bicarbonate in a rabbit model of clomipramine toxicity | journal = Annals of Emergency Medicine | volume = 49 | issue = 2 | pages = 178–85, 185.e1–4 | date = February 2007 | pmid = 17098328 | doi = 10.1016/j.annemergmed.2006.07.016 }}</ref><ref name="Harvey 2009">{{cite journal | vauthors = Harvey M, Cave G, Hoggett K | title = Correlation of plasma and peritoneal diasylate clomipramine concentration with hemodynamic recovery after intralipid infusion in rabbits | journal = Academic Emergency Medicine | volume = 16 | issue = 2 | pages = 151–156 | date = February 2009 | pmid = 19133855 | doi = 10.1111/j.1553-2712.2008.00313.x | doi-access = free }}</ref> and with a clinical report on the use of lipid rescue in veterinary medicine to treat a puppy with [[moxidectin]] toxicosis.<ref name="Crandell 2009">{{cite journal | vauthors = Crandell DE, Weinberg GL | title = Moxidectin toxicosis in a puppy successfully treated with intravenous lipids | journal = Journal of Veterinary Emergency and Critical Care | volume = 19 | issue = 2 | pages = 181–186 | date = April 2009 | pmid = 19691569 | doi = 10.1111/j.1476-4431.2009.00402.x | url = https://zenodo.org/record/898154 }}</ref>