Intractable cardiac arrest due to lidocaine toxicity successfully resuscitated with lipid emulsion.
OBJECTIVE
Demonstrate a case report involving successful use of lipid emulsion therapy for intractable cardiac arrest due to lidocaine toxicity.


METHODS
Lipid emulsion therapy has been shown to be effective in treating the cardiotoxic effects of such drugs as bupivacaine, verapamil, propranolol, and clomipramine as mentioned in a 2009 editorial in Critical Care Medicine by Jeffrey Bent. The mechanism of action of lipid emulsion therapy is not well defined and has been postulated to work by both a "lipid sink," decreasing circulating amounts of drugs to the periphery, or through a direct "energy source" to the myocardium. We present a case report of a patient successfully resuscitated with lipid emulsion therapy after prolonged and intractable lidocaine toxicity. Lidocaine is generally considered much less cardiotoxic than other local anesthetics and is used commonly as infusions for intractable ventricular arrhythmias.


CONCLUSIONS
This case demonstrates the need to consider lipid emulsion therapy in the advanced cardiac life support algorithm for lidocaine toxicity as well as other lipid soluble drug intoxications.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Stephanie K
SK
Dix
Gregg F
GF
Rosner
Monica
M
Nayar
Julian J
JJ
Harris
Maya E
ME
Guglin
Jeffery R
JR
Winterfield
Zhiling
Z
Xiong
Gilbert H
GH
Mudge
D000779:Anesthetics, Local / Q000009:adverse effects*; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods*; D016896:Treatment Outcome
D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous; D008012:Lidocaine