Paediatric Acute care Guidelines PMH Emergency Department

Medication

This guideline can be used for the management of:

  • Lipid Rescue for accidental IV administration

 

Intravenous lipid emulsion  is a novel method for treating local anesthetic systemic toxicity  that also shows promise as an effective antidote for other lipophilic drug poisonings.

Cardiovascular collapse is the most life-endangering complication of intravascular injection during regional anesthesia Local anasthetic systemic toxicity is generally considered to be resistant to conventional modes of resuscitation.

The ‘lipid sink’ phenomenon is the most widely accepted mechanism of action for lipids.The lipid emulsion infusion creates an expanded lipid phase, and the resulting equilibrium drives toxic drug from tissue to the aqueous plasma phase then to the lipid phase. This draws down the content of lipid-soluble local anaesthetics from within the cardiac tissue, thereby improving cardiac conduction, contractility, and coronary perfusion.

Indications

The Intralipid brand of fat emulsion is reserved soley for the emergency management of local anaesthetics inadvertently administered intravenously.

 At PMH, the kit is located:

    • Emergency Department medication room
    • Contained in a grey plastic box
    • Stored on the bottom shelf of the medication shelving (opposite the fridge)
      and should be used for this indication only.

Administration

Give Lipid Emulsion 20% (IntraLipid brand of Fat Emulsion):

    • Bolus 1.5 ml/kg over 1 minute
    • Start infusion at 0.25ml/kg/min
    • Repeat Bolus twice at 5 minute intervals
    • Increase the rate to 0.5ml/kg/min if haemodynamic stability is not restored after boluses
    • Continue infusion until haemodynamic stability is restored
    • Maximum total dose of 8ml/kg is recommended
       10kg      15kg      20kg      25kg      30kg
Bolus
(mls)
15 22.5 30 37.5 45
Infusion Rate
(ml/min)
2.5 3.75 5 6.25 7.5
Infusion Rate
(ml/hour)
150 225 300 375 450
Maximum Dose
(mls)
80 120 160 220 240

 

Special

Lipids are given in addition to standard Cardio-Pulmonary Resuscitation.

 Prompt and effective airway management must be implemented to prevent hypoxia and respiratory acidosis, which may potentiate local anaesthetic toxicity.

Evidence corner

References

 

Tags

We want your feedback!

Help us provide guidelines that are useful to you, the clinician.

Give feedback here