title: The use of dye surrogates to illustrate local anesthetic drug sequestration by lipid emulsion: a visual demonstration of the lipid sink effect.
abstract: OBJECTIVE
  We hypothesized that by substituting a dye surrogate in place of local anesthetic, we could visually demonstrate dye sequestration by lipid emulsion that would be dependent on both dye lipophilicity and the amount of lipid emulsion used.
  
  
  METHODS
  We selected 2 lipophilic dyes, acid blue 25 and Victoria blue, with log P values comparable to lidocaine and bupivacaine, respectively. Each dye solution was mixed with combinations of lipid emulsion and water to emulate "lipid rescue" treatment at dye concentrations equivalent to fatal, cardiotoxic, and neurotoxic local anesthetic plasma concentrations. The lipid emulsion volumes added to each dye solution emulated equivalent intravenous doses of 100, 500, and 900 mL of 20% Intralipid in a 75-kg adult. After mixing, the samples were separated into a lipid-rich supernatant and a lipid-poor subnatant by heparin flocculation. The subnatants were isolated, and their colors compared against a graduated dye concentration scale.
  
  
  RESULTS
  Lipid emulsion addition resulted in significant dye acquisition by the lipid compartment accompanied by a reduction in the color intensity of the aqueous phase that could be readily observed. The greatest amount of sequestration occurred with the dye possessing the higher log P value and the greatest amount of lipid emulsion.
  
  
  CONCLUSIONS
  Our study provides a visual demonstration of the lipid sink effect. It supports the theory that lipid emulsion may reduce the amount of free drug present in plasma from concentrations associated with an invariably fatal outcome to those that are potentially survivable.
authors.affiliation: Department of Anaesthesia and Intensive Care, Worthing Hospital, Western Sussex Hospitals NHS Trust, Worthing, West Sussex, United Kingdom. aipapadopoulou@yahoo.gr
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Papadopoulou
authors.forename: Johann W
authors.initials: JW
authors.lastname: Willers
authors.forename: Theophilus L
authors.initials: TL
authors.lastname: Samuels
authors.forename: David R
authors.initials: DR
authors.lastname: Uncles
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000737:chemistry*; D000880:Anthraquinones / Q000008:administration & dosage / Q000737:chemistry; D002626:Chemistry, Pharmaceutical / Q000295:instrumentation / Q000379:methods*; D003116:Color; D004396:Coloring Agents / Q000008:administration & dosage / Q000737:chemistry*; D004305:Dose-Response Relationship, Drug; D004655:Emulsions; D008055:Lipids / Q000008:administration & dosage / Q000737:chemistry*; D012394:Rosaniline Dyes / Q000008:administration & dosage / Q000737:chemistry
chemical_list: C542340:1-amino-9,10-dihydro-9,10-dioxo-4-(phenylamino)-2-anthracenesulfonic acid; D000779:Anesthetics, Local; D000880:Anthraquinones; D004396:Coloring Agents; D004655:Emulsions; D008055:Lipids; D012394:Rosaniline Dyes; C009662:Victoria blue B