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Monday, April 24, 2017

Q: What is the dose of lipid emulsion in lidocaine toxicity?

 Answer: Lipid emulsion is suggested for lidocaine or local anesthetic toxicity particularly with cardiac arrhythmia or asystole.  It is a 1.5-mL/kg bolus of 20% lipid emulsion solution, followed by a 0.25-mL/kg per minute infusion for 30 to 60 minutes. The bolus can be repeated 1 to 2 times for continued symptoms.

Modus operandi is via "lipid sink". As lidocaine is lipid-soluble, it may reduce the overall plasma concentration. Another mechanism suggested is fostering of cardiac metabolism by augmenting the fatty acid supply, promoting aerobic metabolism and reducing acidosis,


1. Mazoit JX, Le Guen R, Beloeil H, Benhamou D. Binding of long-lasting local anesthetics to lipid emulsions. Anesthesiology. 2009;110(2): 380-386. 

2. Weinberg GL. Lipid infusion therapy: translation to clinical practice. Anesth Analg. 2008 May. 106(5):1340-2

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