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- Local anesthetics work through reversible binding of sodium channels
- If inadvertantly administered intravenously or as an overdose, serious CNS and cardiac toxicities can occur, including seizures, arrhythmias, and cardiovascular collapse
- Fat emulsion has been shown to increase the lethal dose of bupivicaine required, and also resuscitate animals that have local-anesthetic induced cardiac collapse
- There have been successful case reports of patiets treated with fat emulsion that had cardiac arrest, seizures, and EKG changes. All patients recovered successfully with no neurologic sequale
- Regimens used in these cases have included bolus doses between 1.2 -2 ml/kg followed by continuous infusions of 0.25 -0.5 ml/kg/min
- Toxicity may be ameloriated by extracting lipophilic anesthetics from plasma or tissue, or by countering inhibition of myocardial fatty acid oxygenation
References
1. Felice, Kristen. Schumann, Heather. J Med Toxicol. 4(3):184-91, 2008 Sept 4(3):184-91, 2008 Sep.