Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesia• Assess cardiovascular and acid-base status throughout.• Start cardiopulmonary resuscitation (CPR) using standardprotocols.• Consider specific treatment using lipid, magnesium oramiodarone as below.Lipid rescueThe use of 20% lipid solution ‘lipid rescue’ has been reported in asmall body of animal work and in two published case reports inhumans, with apparently dramatic effect. The lipid solution used inthe case reports was Intralipid; the effect is thought to be through a‘lipid sink effect’ whereby the lipophilic local anaesthetic is removedfrom effector sites by the lipid. The lipid solution available in this trustis Clinoleic 20%. Dose recommendations are the same. A fulldescription of evidence, cases and dose recommendations is atwww.lipidrescue.org. It is not appropriate to use propofol or etomidateformulated in lipid.Lipid rescue should be used only after standard resuscitationmethods fail to re-establish sufficient circulatory stability. See theAssociation of Anaesthetists sheet attached to the lipid bag. Briefly,the recommended dose of 20% lipid is 1.5 mL kg -1 as an initial bolusover one minute, followed by 0.25 mL kg -1 min -1 for 30-60 minutes.The bolus could be repeated 1-2 times for persistent asystole. Theinfusion rate could be increased if the blood pressure declines. Themaximum recommended dose is 8 mL kg -1 .Supplies for lipid rescue must be available in for emergency use. Thiswill be in the same locations as used for storage of dantrolene(treatment for malignant hyperpyrexia). The Pharmacy departmentwill maintain the supplies for stock rotation and ensure that thetreatment bags have the recommended dose schedules attached.Magnesium sulphate and amiodaroneMagnesium sulphate is readily available in labour ward, critical careand theatres. Indications and administration are as below.Amiodarone is also widely available.126 Anaesthetists Handbook January 2010