.2024 Feb 14;24(1):138.

doi: 10.1186/s12884-024-06309-1.

Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review

Makoto Tsuji^{1 2}, Masafumi Nii^{3 4}, Marie Furuta^{5 2}, Shinji Baba^{6 2}, Takahide Maenaka^{7 2}, Shigetaka Matsunaga^{8 2}, Hiroaki Tanaka^{9 2}, Atsushi Sakurai^{10 2}; Japan Resuscitation Council (JRC) of the Guideline Editorial Committee

Collaborators, Affiliations

Collaborators

Japan Resuscitation Council (JRC) of the Guideline Editorial Committee:
Rie Kato, Jun Takeda, Masahiro Nakao, Eishin Nakamura, Tomoyuki Yamashita, Yoshinori Yamahata, Naosuke Enomoto, Shinji Baba, Yuki Hosokawa

Affiliations

¹ Department of Obstetrics and Gynecology, Saiseikai Mastusaka General Hospital, Mastusaka, Mie, Japan.
² Japan Resuscitation Council, Shinjuku, Tokyo, Japan.
³ Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan. m-nii1984@med.mie-u.ac.jp.
⁴ Japan Resuscitation Council, Shinjuku, Tokyo, Japan. m-nii1984@med.mie-u.ac.jp.
⁵ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan.
⁶ Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.
⁷ Regional Medical Care Planning Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Tokyo, Japan.
⁸ Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
⁹ Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan.
¹⁰ Department of Acute Medicine, Division of Emergency and Critical Care Medicine, Nihon University School of Medicine, Itabashi, Tokyo, Japan.

PMID:38355477
PMCID: PMC10865663
DOI: 10.1186/s12884-024-06309-1

Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review

Makoto Tsuji et al. BMC Pregnancy Childbirth.2024.

.2024 Feb 14;24(1):138.

doi: 10.1186/s12884-024-06309-1.

Authors

Collaborators

Japan Resuscitation Council (JRC) of the Guideline Editorial Committee:
Rie Kato, Jun Takeda, Masahiro Nakao, Eishin Nakamura, Tomoyuki Yamashita, Yoshinori Yamahata, Naosuke Enomoto, Shinji Baba, Yuki Hosokawa

Affiliations

¹ Department of Obstetrics and Gynecology, Saiseikai Mastusaka General Hospital, Mastusaka, Mie, Japan.
² Japan Resuscitation Council, Shinjuku, Tokyo, Japan.
³ Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan. m-nii1984@med.mie-u.ac.jp.
⁴ Japan Resuscitation Council, Shinjuku, Tokyo, Japan. m-nii1984@med.mie-u.ac.jp.
⁵ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan.
⁶ Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.
⁷ Regional Medical Care Planning Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Tokyo, Japan.
⁸ Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
⁹ Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan.
¹⁰ Department of Acute Medicine, Division of Emergency and Critical Care Medicine, Nihon University School of Medicine, Itabashi, Tokyo, Japan.

PMID:38355477
PMCID: PMC10865663
DOI: 10.1186/s12884-024-06309-1

Abstract

Background: Local anaesthetic systemic toxicity (LAST) is a rare but life-threatening complication that can occur after local anaesthetic administration. Various clinical guidelines recommend an intravenous lipid emulsion as a treatment for local anaesthetic-induced cardiac arrest. However, its therapeutic application in pregnant patients has not yet been established. This scoping review aims to systematically identify and map the evidence on the efficacy and safety of intravenous lipid emulsion for treating LAST during pregnancy.

Method: We searched electronic databases (Medline, Embase and Cochrane Central Register Controlled Trials) and a clinical registry (lipidrescue.org) from inception to Sep 30, 2022. No restriction was placed on the year of publication or the language. We included any study design containing primary data on obstetric patients with signs and symptoms of LAST.

Results: After eliminating duplicates, we screened 8,370 titles and abstracts, retrieving 41 full-text articles. We identified 22 women who developed LAST during pregnancy and childbirth, all presented as case reports or series. The most frequent causes of LAST were drug overdose and intravascular migration of the epidural catheter followed by wrong-route drug errors (i.e. intravenous anaesthetic administration). Of the 15 women who received lipid emulsions, all survived and none sustained lasting neurological or cardiovascular damage related to LAST. No adverse events or side effects following intravenous lipid emulsion administration were reported in mothers or neonates. Five of the seven women who did not receive lipid emulsions survived; however, the other two died.

Conclusion: Studies on the efficacy and safety of lipids in pregnancy are scarce. Further studies with appropriate comparison groups are needed to provide more robust evidence. It will also be necessary to accumulate data-including adverse events-to enable clinicians to conduct risk-benefit analyses of lipids and to facilitate evidence-based decision-making for clinical practice.

Keywords: Anaesthesia; Analgesia – Obstetric; Emergency medicine; Lipid emulsion; Resuscitation; Shock.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
PRISMA flowchart of papers screening process

See this image and copyright information in PMC

References

1. Mulroy MF, Hejtmanek MR. Prevention of local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010;35(2):177–180. doi: 10.1097/AAP.0b013e3181d26068. - DOI - PubMed
1. Bern S, Weinberg G. Local anesthetic toxicity and lipid resuscitation in pregnancy. Curr Opin Anaesthesiol. 2011;24(3):262–267. doi: 10.1097/ACO.0b013e32834654df. - DOI - PubMed
1. Mulroy MF. Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures. Reg Anesth Pain Med. 2002;27(6):556–561. - PubMed
1. Christie LE, Picard J, Weinberg GL. Local anaesthetic systemic toxicity. Bja Educ. 2015;15(3):136–142. doi: 10.1093/bjaceaccp/mku027. - DOI
1. El-Boghdadly K, Chin KJ. Local anesthetic systemic toxicity: Continuing Professional Development. Can J Anesth. 2016;63(3):330–349. doi: 10.1007/s12630-015-0564-z. - DOI - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions
Actions

LinkOut - more resources

Full Text Sources

Movatterモバイル変換

Account

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Full text links

Actions

Share

Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review

Collaborators

Affiliations

Intravenous lipid emulsion for local anaesthetic systemic toxicity in pregnant women: a scoping review

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources