Refer to the table below for dose recommendations. Give Lipid Emulsion 20% (Intralipid® brand of Fat Emulsion). For signs of local anaesthetic toxicity and immediate management, refer to Management of Severe Local Anaesthetic Toxicity Guideline 2010 2.No other brands of lipid emulsions are to be used. The Intralipid® brand of fat emulsion is reserved solely for the emergency management of local anaesthetics inadvertently administered intravenously.This draws down the content of lipid-soluble local anaesthetics from within the cardiac tissue, thereby improving cardiac conduction, contractility and coronary perfusion.The lipid emulsion infusion creates an expanded lipid phase, and the resulting equilibrium drives toxic drug from tissue to the aqueous plasma phase then into the lipid phase.The ‘lipid sink’ phenomenon is the most widely accepted mechanism of action for lipids.Only Intralipid® brand should be used for the treatment of acute local anaesthetic toxicity.Local anaesthetic systemic toxicity is generally considered to be resistant to conventional modes of resuscitation.1 Key principles Intravenous Local Anaesthetic Toxicity 1 Intravenous lipid emulsion administration is an established clinical practice for treating local anaesthetic systemic toxicity that also shows promise as an effective antidote for other lipophilic drug poisoning.

BackgroundĬardiovascular collapse is the most life-endangering complication of intravascular injection during regional anaesthesia. This guideline can be used for the management of Lipid Rescue for accidental IV administration of local anaesthetic. To guide PCH Emergency Department (ED) staff in the administration of lipid infusion (Intrapid 20%®) for the acute management of local anaesthetic toxicity following inadvertent intravascular injection during regional anaesthesia in the ED. Clinicians should also consider the local skill level available and their local area policies before following any guideline. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinical common-sense should be applied at all times. They are not strict protocols, and they do not replace the judgement of a senior clinician. These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. Lipid infusion for local anaesthetic toxicity Disclaimer

Lipid emulsion