The potential use of intralipid to minimize propofol’s cardiovascular effects
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- Gragasin, F.S., Davidge, S.T. & Tsui, B.C.H. Can J Anesth/J Can Anesth (2009) 56: 170. doi:10.1007/s12630-008-9031-4
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To the Editor
Many reports exist which advocate the use of intralipid to reverse local anesthetic cardiovascular toxicity. The precise mechanism of action, while unknown at the present time, may include a combination of reduced tissue binding of local anesthetic by a plasma-lipid phase and a beneficial metabolic effect involving cardiac mitochondria.1 We hypothesized that intralipid can also function as a cardiovascular reversal agent for propofol.
Propofol is available commercially as a mixture in intralipid, where soybean oil holds the bulk of the propofol.5 Therefore, we propose that intralipid can serve as a “propofol mop” by extracting propofol from its site of action (e.g., hydrophobic pockets of membrane proteins). It is unlikely to be a dilutional effect, since the corresponding volume of saline added to the tissue baths did not reverse the vasodilation. We suggest that intralipid may inhibit the untoward effects of propofol at the vascular level, since previous findings have demonstrated that only small amounts of intralipid cross the blood-brain barrier.6 Therefore, with the administration of intralipid, the actions of propofol on sedation/consciousness have the potential to be unaltered, without cardiovascular depression. As mentioned above, intralipid is being advocated as an antidote for local anesthetic toxicity, and we propose an additional role to minimize propofol’s untoward cardiovascular side-effects. Similar to treatment for local anesthetic toxicity, further studies taking the bench-to-bedside approach will need to be completed to determine the minimum amount of intralipid necessary to reverse the cardiovascular effects of propofol in vivo. Dose-finding studies utilizing this type of experimental set-up, followed by the use of whole animal models, will be required to address this question.
Conflicts of interest