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Lipid, Not Propofol, Treats Bupivacaine Overdose

Mayr, Viktoria D. MD; Raedler, Claus MD; Wenzel, Volker MD; Lindner, Karl H. MD; Strohmenger, Hans-Ulrich MD

doi: 10.1213/01.ANE.0000138550.57760.22
Letters to the Editor: Letters & Announcements

Univ. Klinik f. Anaesthesie u. Allg. Intensivmedezin; Innsbruck, Austria;

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In Response:

We would like to thank Weinberg et al. for their interest in our work, as well as for their constructive comments. First, we sincerely apologize for having incorrectly cited Weinberg et al. by confounding propofol and intralipid; we completely agree with their statement that propofol administration cannot be recommended for managing a bupivacaine overdose. When indicating in the Discussion section that “... a lipid infusion such as propofol increases the dose of bupivacaine required to induce cardiac arrest, and therefore, this strategy has been suggested as a potential means to improve outcomes from such toxicity,” we did not suggest to use propofol for treating bupivacaine toxicity, nor that Dr. Weinberg et al. used propofol for treating bupivacaine toxicity. We share the same opinion that usage of propofol in cardiac arrest may impede resuscitation. With our statement about a “lipid infusion such as propofol...”, we only wanted to state the reason why we did not use propofol but isoflurane and nitrous oxide to maintain anesthesia in our experiment. Instead of saying “... a lipid infusion such as propofol...”, it would have been better to state “... as propofol is a lipid infusion which may increase the dose of bupivacaine required to induce cardiac arrest...” Second, beneficial lipid effects during massive bupivacaine overdose as described by Weinberg et al. resulted in impressive outcome data. However, their conclusion drawn in the letter that these results indicate the superiority of this treatment regime in comparison to advanced cardiac life support including epinephrine and vasopressin has not been proven. The comparative investigation of the epinephrine/vasopressin combination and the lipid rescue protocol in the same animal model of bupivacaine cardiac toxicity can only provide reliable information in this respect.

Viktoria D. Mayr, MD

Claus Raedler, MD

Volker Wenzel, MD

Karl H. Lindner, MD

Hans-Ulrich Strohmenger, MD

Univ. Klinik f. Anaesthesie u. Allg. Intensivmedezin

Innsbruck, Austria

© 2004 International Anesthesia Research Society