title: [Intravenous lipid emulsion and local anesthetic-induced systemic toxicity: mechanisms and limits].
abstract: OBJECTIVE
  Intravenous lipid emulsions (ILE) are recommended today in cases of local anesthetic-induced systemic toxicity (LAST). The objectives of this review consists in describing mechanisms involved in the interaction between ILE and local anesthetic (LA) factors influencing this interaction and the limits associated with the use of ILE.
  
  
  METHODS
  References were obtained from Pubmed data bank (http://www.ncbi.nlm.nih.gov/pubmed) using the following keywords: Intralipid(®), local anesthetic, toxicity, intravenous lipid emulsion.
  
  
  RESULTS
  Effects of the association between ILE-LA are based on droplet formations as well as changes in cell metabolism involving survival cell pathway, on functional properties and on direct hemodynamic parameters. Hypoxia, acidosis and high doses of epinephrine modified the effects of ILE-LA association.
  
  
  CONCLUSIONS
  Prescription of ILE is recommended by published guidelines on LAST resuscitation. ILE cannot substitute to the standard resuscitation protocol. It should be added to that protocol. Experimental studies as well as a case report registry will allow understanding further the effects induced by the ILE-LA association.
authors: Laboratoire maladies rares : génétique et métabolisme (MRGM), université Segalen Bordeaux 2, 33076 Bordeaux, France; Pôle d'anesthésie-réanimation, centre François Xavier-Michelet, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France. Electronic address: karine.nouette-gaulain@chu-bordeaux.fr.
authors: K
authors: K
authors: Nouette-Gaulain
authors: Inserm U1046, département d'anesthésie-réanimation, hôpital Lapeyronie, CHU de Montpellier, bâtiment Inserm Crastes de Paulet, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France; Pôle d'anesthésie-réanimation samu urgences, université Rennes 1, UMR 991, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors: X
authors: X
authors: Capdevila
authors: Laboratoire maladies rares : génétique et métabolisme (MRGM), université Segalen Bordeaux 2, 33076 Bordeaux, France.
authors: F
authors: F
authors: Robin
authors: Pôle d'anesthésie-réanimation samu urgences, université Rennes 1, UMR 991, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
authors: H
authors: H
authors: Beloeil
mesh_terms: D000779:Anesthetics, Local / Q000009:adverse effects*; D004347:Drug Interactions; D062787:Drug Overdose / Q000628:therapy; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans
chemical_list: D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous
keywords: Anesthésique local; Intralipid(®); Intralipide(®); Intravenous lipid emulsion; Local anesthetic; Toxicity; Toxicité systémique; Émulsion lipidique intraveineuse