![]() ![]() The fatty acids from the ILE provide the myocardium a ready energy source and thus improve cardiac function. The second theory postulates that local anesthetics interrupt the transport of fatty acids to the cardiac mitochondria, thereby reducing energy supply. 9 It is highly likely that mechanisms other than the lipid sink contribute to the beneficial action of ILE. 6- 8 In vitro models suggested that the mechanism underlying ILE binding to a drug is mostly dependent on the drug’s lipid partition constant and volume of distribution. ![]() Various in vitro and in vivo studies have confirmed the benefits of the lipid sink effect. The emulsion acts as a lipid sink, surrounding a lipophilic drug molecule and rendering it ineffective. Nonetheless, numerous mechanisms are believed to contribute to its effectiveness. The mechanism of action of ILE in the management of poisoning is not completely understood. The purpose of this review was to examine significant advances in our understanding of the efficacy and safety of ILE, with specific emphasis on its use in local anesthetic toxicity.Mechanisms of effect and clinical use Furthermore, some trials assessed the safety of ILE in the treatment of acute poisoning. 5 The case and anecdotal reports reveal that ILE therapy holds promise in the management of toxicity induced by various lipophilic agents, including drugs and pesticides. Presley and Chyka accumulated findings on pediatric applications of ILE and proposed that a vast majority of the pediatric cases exhibited a positive response to the procedure, despite being unresponsive to standard resuscitation methods. 4 Intravenous lipid emulsion therapy has also been beneficial in neonates and children. 3 In recent years, this therapy has become one of the most commonly recommended treatment modalities by most US poison control centers for patients who have suffered cardiac arrest or with hemodynamic compromise following xenobiotic toxicity. The first case report on the use of intravenous lipid emulsion (ILE) therapy as a rescue or antidotal therapy for acute drug poisoning was published in 2006. Nearly 85% of the fatty acid profile in soybean oil is composed of 3 18-carbon, long-chain unsaturated fatty acids and the remaining 15% is composed of saturated fatty acids such as palmitic and stearic acids. The soybean oil-based IV fat emulsions contain a substantial amount of nonessential w-9 fatty acid oleic acid, which accounts for approximately 25% of the fatty acid content. 2 Linoleic acid constitutes almost 50% of the total fatty acid profile. 1 Widely used lipid solutions mainly contain soybean oil, which is composed of linoleic acid, alpha linolenic acid, alpha tocopherol, and phytosterols. Of note, lipid emulsions containing fish oil have less proinflammatory characteristics, which exerts beneficial effects on immune system and organ functions. The main difference after these ancestor products took place in the oil composition-triglycerides of plant and marine oil origin. Originally, these were lipid-rich formulations used to provide intravenous calorific and nutritional support. Lipid injectable emulsions have been in the market since the 1960s and used clinically with certain benefits. The advantages of ILE include an apparent wide margin of safety, relatively low cost, long shelf-life, and ease of administration. The most common adverse effects from standard ILE include hypertriglyceridemia, fat embolism, infection, vein irritation, pancreatitis, electrolyte disturbances and allergic reactions. In patients with hemodynamic compromise and/or cardiovascular collapse due to lipid-soluble agents, ILE may be considered for resuscitation in the acute setting by emergency physicians. Efficiency of ILE was demonstrated in animal studies in the treatment of severe impairment of cardiac functions, via a mechanism for trapping lipophilic drugs in an expanded plasma lipid compartment (“lipid sink”). There are increasing data suggesting use of ILE in reversing from local anesthetic-induced systemic toxicity severe, life-threatening cardiotoxicity, although findings are contradictory. The use of intravenous lipid emulsion (ILE) therapy as antidote in systemic toxicity of certain agents has gained widespread support.
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