국소마취제를 포함한 약물중독에서 해독제로서의 lipid emulsion

Although intravenous lipid emulsion (LE) is used mainly for parenteral nutrition, recently it has been used to treatpatients with cardiopulmonary resuscitation (CPR)-resistant cardiovascular collapse induced by a toxic dose of localanesthetics or other drugs. Intravenous LE resolves symptoms of local anesthetic systemic toxicity, including convulsion,myoclonus, loss of consciousness, cardiac arrest, supraventricular tachycardia, and ventricular fibrillation. The mainunderlying mechanisms suggested to be responsible for LE-induced reversal of cardiac arrest due to drug toxicity arethe lipid sink effect and the metabolic effect. The lipid sink theory posits that LE extracts a lipid-soluble toxic drug fromthe tissue. When a patient with cardiovascular collapse induced by a local anesthetic or another lipid-soluble drug isunresponsive to supportive treatments, including CPR and vasopressor therapy, LE administration can be considered. Thesuggested dosing regimen is as follows: 1) an initial intravenous bolus administration of 20% LE (1.5 mL/kg) is followedby a continuous infusion of 20% LE (0.25 mL/kg/min); and 2) when hemodynamic functions are unstable after the initialLE infusion, an intravenous administration of 20% LE (1.5 mL/kg) is repeated and followed by an increased continuousinfusion of 20% LE (0.5 mL/kg/min). Further research is warranted regarding other possible mechanisms of LE’s effect,the timing of LE administration, and the effect of various fatty acids on the LE-mediated reversal of cardiac arrest. Thisarticle reviews case reports and experimental evidence concerning the LE-mediated reversal of intractable cardiac arrestinduced by drug toxicity, the underlying mechanism, and the dosing regimen. KCI Citation Count: 0