What is the recommended dosing regimen for lipid emulsion therapy for local anesthetic toxicity?

Updated: Jan 09, 2019
  • Author: Raffi Kapitanyan, MD; Chief Editor: David Vearrier, MD, MPH  more...
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Answer

Lipid emulsion therapy is performed with a 20% solution. [29]  The 2020 ASRA guidelines state that the order of administration (bolus or infusion) and the method of infusion are not critical. For patients who weigh less than 70 kg, administer a bolus of 1.5 mL/kg over 2 - 3 minutes. [30, 8, 2]  or an infusion at a rate of 0.25 mL/kg/min. [2]  For patients weighing < 40 kg, consider using a pump for infusion.  For patients who weigh more than 70 kg, administer a bolus of 100 mL over 2-3 minutes or an infusion of 250 mL over 15-20 min. [2]

If this regimen does not provide adequate resuscitation, the bolus can be repeated or the infusion doubled. The recommended upper limit of lipid emulsion is 12 mL/kg over the first 30 minutes; staying within that limit is particularly important in children and small adults. Much smaller doses are typically needed. [2]

Note that propofol is not a component of lipid rescue. It is formulated in a 10% lipid emulsion, and, therefore, an overdose of propofol (gram quantities) would be necessary to provide an adequate dose of lipid emulsion. Propofol is contraindicated when any evidence of cardiovascular toxicity is present. [1]


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