Abstract
To evaluate hemodynamic changes caused by sole intravenous infusion of lipid emulsion with doses recommended for treatment of drug-related toxicity. Large White pigs underwent general anesthesia, tracheal intubation was performed, and mechanical ventilation was instituted. Hemodynamic variables were recorded using invasive blood pressure and pulmonary artery catheterization. Baseline hemodynamic measurements were obtained after a 30-minute stabilization period. An intravenous bolus injection of 20% lipid emulsion at 1.5 ml/kg was administered. Additional hemodynamic measurements were made after 1 minute, followed by a continuous intravenous lipid infusion of 0.25 ml/kg/min. Further measurements were carried out at 10, 20 and 30 minutes, when the infusion was doubled to 0.5 ml/kg/min. Assessment of hemodynamic changes were then made at 40, 50 and 60 minutes. Lipid infusion did not influence cardiac output or heart rate, but caused an increase in arterial blood pressure, mainly pulmonary blood pressure due to increased vascular resistance. Ventricular systolic stroke work consequently increased with greater repercussions on the right ventricle. In doses used for drug-related toxicity, lipid emulsion cause significant hemodynamic changes with hypertension, particularly in the pulmonary circulation and increase in vascular resistance, which is a factor to consider prior to use of these solutions.
Highlights
MethodsLipid therapy for treatment of drug-related toxicity was first used in 1998 by Weinberg et al.[1]
Mazoit et al.[6] have failed to find any beneficial effect! But what draws attention to this therapy is that infusion regimens recommended in parenteral nutrition range from 7001,300 mg of triglycerides/kg/day and serum levels of triglyceride should be monitored to decrease infusion rates if triglyceride levels achieve 400 mg/dl
The aim of this study was to confirm in our setting the hemodynamic changes in a swine model caused by sole intravenous infusion of lipid emulsion based on doses recommended for treatment of drug-related toxicity in humans
Summary
Lipid therapy for treatment of drug-related toxicity was first used in 1998 by Weinberg et al.[1] Those authors successfully employed lipid emulsion to combat toxicity of the local anesthetic bupivacaine in animal models. It is the same lipid used for years as a parenteral nutrition formulation. Medical societies recommend a bolus injection of 1.5 ml/kg, followed by a continuous infusion rate of 0.25 ml/kg/min of 20% lipid emulsion. The aim of this study was to confirm in our setting the hemodynamic changes in a swine model caused by sole intravenous infusion of lipid emulsion based on doses recommended for treatment of drug-related toxicity in humans
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