Lipid Emulsion 20% (Intralipid)

How it works

In toxicity it is thought to act as a 'lipid sink', partitioning lipophilic drug away from cardiac and neural tissue, and may also provide a cardiac metabolic and direct cardiotonic benefit.

Prescribing in practice

• In suspected local anaesthetic systemic toxicity it should be given alongside high-quality cardiopulmonary resuscitation and standard advanced life support, following the resuscitation council / anaesthetic guideline.
• Repeated or large cumulative volumes can cause fat overload; an upper cumulative limit is specified in guidance.
• It is not a substitute for airway, breathing, and circulation management and seizure control.

Monitoring

Monitor cardiovascular recovery, and where prolonged or repeated dosing is used, watch for signs of fat overload such as deranged clotting or organ dysfunction.

Counselling the patient

• This is an emergency antidote administered by the resuscitation team.
• The patient should be observed in a monitored setting after recovery as toxicity can recur.

Evidence & guidelines

Use is supported by Association of Anaesthetists guidance on the management of severe local anaesthetic toxicity.