Intralipid rescue for local anaesthetic systemic toxicity (LAST)

In recent local discussions, the validity of evidence fro intralipid rescue has been challenged. Why?

Discussion:- Despite being included in authoritative guidelines currently being used for anaesthetic emergency training purposes, the evidence for intralipid rescue is not as robust as is commonly perceived. Although some are strong advocates, others regard the evidence as weakly positive for bupivicaine toxicity but very questionable for other local anaesthetics (see References).

Rosenberg PH Current evidence is not in support of lipid rescue therapy in local anaesthetic systemic toxicity Acta Anaesthesiologica Scandinavica 2016; 60:1029–1032

Weinberg G Current evidence supports use of lipid rescue therapy in local anaesthetic systemic toxicity Acta Anaesthesiologica Scandinavica 2017;61: 365–368

Rosenberg 2016

Weinberg 2017

Hayes et al 2016

Mullins 2017

Gosselin 2017

Hoegberg Gosselin 2017

Harvey Cave 2016

Hojer 2016