The question remains, then, what will now be your response when a patient shows signs and symptoms of local anesthetic toxicity with, or even before, failing CPR? Does the growing number of case reports documenting successful resuscitation via the use of lipid emulsion therapy intrigue you enough to have the drug readily available where blocks are performed in your practice? Will you abide the wise counsel from de Jong that lipid therapy is not a panacea for all forms of toxicity?Will you proceed with the surgical case after your patient has recovered from a local anesthetic overdose by treatment with lipid emulsion? The weight of the evidence, based upon case report quality data, is not overwhelming, but must we wait for more detailed research to specify all of the clinical innuendos for using this treatment? Although the hazards of the doses of lipid given in this therapy are not known, for a patient in the desperate circumstance of local anesthetic toxicity and failing or failed resuscitation, lipid emulsion therapy seems to be a worthy and effective consideration. It would be naive to substitute this treatment for standard CPR, but it is not premature to apply it once it is clear that the likely explanation for a patient’s cardiovascular collapse is local anesthetic toxicity and when conventional resuscitation efforts are not generating success. This conclusion is not based on a flash-in-a-pan experiment but rather, on a methodical, scientific evolution of a concept tested in more than one animal model, and now showing dramatic results in a few humans.
