, Volume 4, Issue 2, pp 71-76

Intralipid infusion ameliorates propranolol-induced hypotension in rabbits

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Abstract

Objective

Recent case reports of successful amelioration of lipid-soluble drug toxidromes with Intralipid infusion have prompted interest in the scope of lipid emulsions as antidotal therapy. Propranolol is a highly lipid-soluble, nonselective beta-blocker with additional local-anaesthetic properties. We explored the hypothesis that propranolol toxicity may be similarly attenuated by Intralipid infusion in a rabbit model.

Methods

Twenty sedated, invasively monitored, and mechanically ventilated New Zealand White rabbits underwent propranolol infusion at 4.2 mg/min to a target mean arterial pressure (MAP) of 60% baseline MAP. Animals subsequently received 6 ml/kg 20% Intralipid, or 6 ml/kg 0.9% saline solution over a 4-minute period. Pulse rate and MAP were recorded at 2.5-minute intervals to 15 minutes.

Results

MAP was greatest in the Intralipid group (median 69 mmHg, interquartile range [IQR] 17.5 mmHg Intralipid vs. median 53 mmHg, IQR 12.75 mmHg saline;p = 0.029) at 15 minutes. No difference was observed in first derivative of MAP, or pulse rate between groups.

Conclusions

Propranolol-induced hypotension is ameliorated by Intralipid infusion in this intact rabbit model. The mechanism of action remains to be elucidated.

This study was funded via a grant from the Morson Taylor Research Award. The authors would like to thank Mr. Ric Broadhurst for his assistance in animal handling and procedure performance, and Pacific Pharmaceuticals for provision of pure substance propranolol.