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Lokalanästhetikaintoxikation und „lipid resuscitation“

Local anesthetic intoxication and lipid resuscitation

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Zusammenfassung

Hintergrund

Tierexperimentelle Studien und zahlreiche Fallberichte legen die Vermutung nahe, dass die Therapie der Lokalanästhetikaintoxikation mit Lipidinfusionen effektiv ist. Der Wirkmechanismus ist noch unbekannt, es existieren jedoch zwei Theorien. Zum einen die Metabolismus-Theorie, die besagt, dass die Gabe von Lipiden bei Intoxikationen mit Lokalanästhetika zu einer verbesserten Stoffwechselsituation des Herzens und des Gehirns führen und dadurch die Intoxikationssymptome abgeschwächt werden. Die zweite Theorie ist die Lipidsenken-Theorie („lipid sink“). Diese Lipidsenken-Theorie wird in letzter Zeit favorisiert und besagt, dass die Lipide einen zusätzlichen intravasalen Raum oder ein Kompartiment schaffen, wohin das Lokalanästhetikum verschwinden kann.

Methode

Selektive Recherche der Literatur und Homepages.

Schlussfolgerungen

Die Lipidtherapie hat ihre Wirksamkeit nicht nur bei Lokalanästhetikaintoxikationen, sondern auch bei Intoxikationen mit anderen lipophilen Substanzen, z. B. mit (trizyklischen) Antidepressiva, Antiepileptika, lipophilen β-Blockern oder Kalziumkanalblockern gezeigt. Nationale und internationale Fachgesellschaften empfehlen die Gabe von Lipidemulsionen zur Therapie der Lokalanästhetikaintoxikationen. Weitere Fallbeispiele und tierexperimentelle Studien werden den Fokus auf die Frage nach Nebenwirkungen, optimaler Dosierung und der Wirksamkeit bei Intoxikationen mit anderen Medikamenten lenken müssen.

Abstract

Background

Animal experimental studies and many case reports lead to the conclusion that lipid therapy is effective for the treatment of local anesthetic toxicity. The mechanism of action is still unknown but two main theories exist. The first one, the metabolism theory, focuses on a possible metabolic effect of lipids to reduce tissue acidosis and decrease carbon dioxide production during periods of myocardial ischemia. The second theory is the lipid sink theory where the lipid emulsion provides a large lipid phase in serum with the ability to extract lipophilic drugs.

Method

Selective review of the literature and homepages.

Conclusions

Lipid therapy is not only effective in the treatment of local anesthetic toxicity. Intoxication with other lipophilic drugs, e.g. (tricyclic) antidepressants, anticonvulsant drugs, lipophilic beta blockers or calcium channel blockers can also be treated with lipids. National and international societies recommend the administration of lipid emulsions for the therapy of local anesthetic intoxication. Further case reports and animal studies will focus on side effects, optimal dosage and effectiveness in the treatment of intoxication with other drugs.

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C. Plata, B.W. Böttiger and O. Dagtekin declare that they have no conflict of interest.

 

This article does not contain any studies with human or animal subjects.

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  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Kerpener Straße 62, 50937, Köln, Deutschland

    C. Plata, B. W. Böttiger & O. Dagtekin

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  1. C. Plata
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Plata, C., Böttiger, B. & Dagtekin, O. Lokalanästhetikaintoxikation und „lipid resuscitation“. Notfall Rettungsmed 16, 188–195 (2013). https://doi.org/10.1007/s10049-013-1687-9

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