Intralipid
Intralipid is a brand name for the first safe fat emulsion for human use, approved in 1962 in Europe and invented by Professor Arvid Wretlind, Sweden. The FDA initially would not approve the product due to prior experience with another fat emulsion. It was approved in the United States in 1972. It is used as a component of parenteral nutrition for patients who are unable to get nutrition via an oral diet. It is an emulsion of soy bean oil, egg phospholipids and glycerin. It is available in a 10%, 20% and 30% concentration. The 30% concentration is not approved for direct intravenous infusion, but should be mixed with amino acids and dextrose as part of a total nutrient admixture.
Intralipid provides essential fatty acids, linoleic acid (LA), an omega-6 fatty acid, alpha-linolenic acid (ALA), an omega-3 fatty acid.
Some preparations of the anaesthetic drugs propofol and etomidate (the vehicle for etomidate is propylene glycol) are supplied using Intralipid as a vehicle.
Use as an antidote
Weinberg et al. have published data indicating Intralipid is effective in treating experimental models of severe cardiotoxicity secondary to intravenous overdose of local anaesthetic drugs such as bupivacaine. [1] [2] [3] [4] Recent case reports have been published of the successful use of lipid emulsion in this way [5] [6] [7] to save patients who were unresponsive to the usual resuscitation methods. All patients recovered completely shortly after intravenous injections of lipid. It has subsequently been used off-label in the treatment of overdose from other fat-soluble medications.[8]
Use in research
Intralipid is also widely used in optical experiments to simulate the scattering properties of biological tissues. [9] Solutions of appropriate concentrations of intralipid can be prepared that closely mimic the response of human or animal tissue to light at wavelengths in the red and infrared ranges where tissue is highly scattering but has a rather low absorption coefficient.
References
- ↑ Picard J, Meek T (February 2006). "Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob". Anaesthesia 61 (2): 107–9. doi:10.1111/j.1365-2044.2005.04494.x. PMID 16430560.
- ↑ Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ (April 1998). "Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats". Anesthesiology 88 (4): 1071–5. doi:10.1097/00000542-199804000-00028. PMID 9579517.
- ↑ Weinberg G, Ripper R, Feinstein DL, Hoffman W (2003). "Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity". Reg Anesth Pain Med 28 (3): 198–202. doi:10.1053/rapm.2003.50041. PMID 12772136.
- ↑ Weinberg G. Reply to Drs. Goor, Groban and Butterworth – Lipid rescue: Caveats and recommendations for the "silver bullet" (letter). Regional Anesthesia and Pain Medicine 2004; 29: 74.
- ↑ Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB (July 2006). "Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest". Anesthesiology 105 (1): 217–8. doi:10.1097/00000542-200607000-00033. PMID 16810015.
- ↑ Litz RJ, Popp M, Stehr SN, Koch T (August 2006). "Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion". Anaesthesia 61 (8): 800–1. doi:10.1111/j.1365-2044.2006.04740.x. PMID 16867094.
- ↑ Foxall G, McCahon R, Lamb J, Hardman JG, Bedforth NM (May 2007). "Levobupivacaine-induced seizures and cardiovascular collapse treated with Intralipid". Anaesthesia 62 (5): 516–8. doi:10.1111/j.1365-2044.2007.05065.x. PMID 17448066.
- ↑ Mahoney, Diana. "IV Fat Emulsion Beneficial for Some Drug Overdoses". Acep.org. Elsevier Global Medical News. Retrieved 3 November 2013.
- ↑ Driver I, Feather J W, King P R, Dawson J B. The optical properties of aqueous suspensions of Intralipid, a fat emulsion. Physics in Medicine and Biology 1989, Vol.34 No. 12, 1927–1930.
External links
- Lipid rescue (intralipid as antidote)