Intravenous lipid emulsion and local anesthetic-induced systemic toxicity: Mechanisms and limits

Objectives. - Intravenous lipid emulsions (ILE) are recommended today in cases of local anesthetic-induced systemic toxicity (LAST). The objectives of this review consists in describing mechanisms involved in the interaction between ILE and local anesthetic (LA) factors influencing this interaction and the limits associated with the use of ILE. Data sources. - References were obtained from Pubmed data bank (http://www.ncbi.nlm.nih.gov/pubmed) using the following keywords: Intralipid, local anesthetic, toxicity, intravenous lipid emulsion. Data synthesis. - Effects of the association between ILE-LA are based on droplet formations as well as changes in cell metabolism involving survival cell pathway, on functional properties and on direct hemodynamic parameters. Hypoxia, acidosis and high doses of epinephrine modified the effects of ILE-LA association. Conclusion. - Prescription of ILE is recommended by published guidelines on LAST resuscitation. ILE cannot substitute to the standard resuscitation protocol. It should be added to that protocol. Experimental studies as well as a case report registry will allow understanding further the effects induced by the ILE-LA association. (C) 2014 Published by Elsevier Masson SAS on behalf of the Societe francaise d'anesthesie et de reanimation (Sfar).