Der Anaesthesist

, Volume 59, Issue 6, pp 575–586

Lipidlösungen zur Therapie der Lokalanästhetikaintoxikation

(LipidRescueTM)
CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Intoxikationen mit Lokalanästhetika sind seltene, aber potenziell lebensbedrohliche Komplikationen. Besonders lang wirksame Lokalanästhetika können aufgrund ihrer hohen Lipophilie einen prolongierten Kreislaufstillstand verursachen. Zentralnervöse Symptome, wie Verwirrtheit, Schwindel und Krampfanfälle, sind häufige Vorboten einer Kreislaufdekompensation. In ersten Fallberichten am Menschen konnten Lipidlösungen nach Intoxikation mit Lokalanästhetika stabile Kreislaufverhältnisse zügig wiederherstellen. Bei begründetem Verdacht auf eine Intoxikation sollte die Lokalanästhetikazufuhr – wenn möglich – umgehend unterbrochen und eine Hypoxie bzw. Acidose durch Sauerstoffgabe sowie Beatmung verhindert werden. Ein Krampfanfall sollte medikamentös durchbrochen werden. Bei auftretendem Kreislaufstillstand muss die leitliniengerechte Reanimation erfolgen. Erst danach ist als Ergänzung zur herkömmlichen Reanimation eine Lipidgabe indiziert. Lipidlösungen sollten in allen Räumlichkeiten verfügbar sein, in denen Lokalanästhetika Verwendung finden.

Schlüsselwörter

Kardiotoxizität Lipidemulsion Intoxikation Lokalanästhetika Reanimation 

Lipid emulsion therapy for local anaesthetic toxicity

(LipidRescue™)

Abstract

Intoxication due to local anaesthetic drugs poses a rare but potentially life-threatening complication. In particular long-acting local anaesthetics can cause refractory cardiac arrest due to their lipophilic properties. This is often preceded by neurological symptoms such as confusion, vertigo and tonic-clonic seizures. The clinical efficacy of lipid emulsions in resuscitation from local anaesthetic toxicity has been documented in multiple publications. The injection of local anaesthetics should be stopped immediately upon the first presentation of symptoms. Securing the airway is mandatory to avoid hypoxia and concurrent acidosis. A seizure should be controlled with adequate doses of anticonvulsants. In case of cardiac arrest standard protocols for cardiopulmonary resuscitation have to be implemented immediately. The use of lipid emulsion can then be initiated as a supplement to standard resuscitation. It is recommended that lipid emulsions are instantly accessible in all facilities where local anaesthetics are administered.

Keywords

Cardiotoxicity Lipid emulsion Intoxication Local anaesthetics Resuscitation 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Klinik für Anästhesiologie und Operative IntensivmedizinKlinikum AugsburgAugsburgDeutschland

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