Lipid Emulsion / IntraLipid

Indications:  

• Refractory life-threatening cardiotoxicity secondary to bupivacaine. 
• There is minimal to no evidence to support its use as a first line agent in toxicity  related to other agents including other local anaesthetic agents or other  compounds.
• Its use can be considered as a rescue therapy in life-threatening, treatment  refractory cardiotoxicity due to lipophilic agents
• It is NOT indicated in seizures or stable dysrhythmias
• Consider the role of other agents such as NaHCO3 in local anaesthetic toxicity or TCA  overdose 

Formulation: 

• 20% Intralipid Emulsion in 100ml or 500ml bottle / bag 

Dosage and Administration: 

• 1.5ml/kg bolus dosage over 1 minute
• Infusion of 15ml/kg/ hr (0.25ml/kg/min) 

If no improvement in haemodynamic stability (persistent shock and dysrhythmias or  arrest) over 5 minutes consider repeat bolus and double infusion rate to 30ml/kg/hr  (0.5ml/kg/min) 

• Maximum dose should not exceed 12ml/kg
• End point: Stability or maximum dose reached 

Side Effects: 

• Contraindication: anaphylaxis to soy beans or egg
• Pancreatitis
• ECMO filter dysfunction
• Lipaemic blood samples resulting in lab errors
• Acute lung injury (fat embolus) 

Pit Falls: 

• Failure to use standard resuscitative measures in cardiotoxic overdose including the  use of vasoactive agents and NaHCO3