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The Use of Dye Surrogates to Illustrate Local Anesthetic Drug Sequestration by Lipid Emulsion: A Visual Demonstration of the Lipid Sink Effect

Papadopoulou, Aikaterini MB, BS; Willers, Johann W. MB, ChB; Samuels, Theophilus L. MB, BS; Uncles, David R. MB, BS

Regional Anesthesia and Pain Medicine: March/April 2012 - Volume 37 - Issue 2 - p 183–187
doi: 10.1097/AAP.0b013e318244b2b7
ORIGINAL ARTICLES

Background and Objectives We hypothesized that by substituting a dye surrogate in place of local anesthetic, we could visually demonstrate dye sequestration by lipid emulsion that would be dependent on both dye lipophilicity and the amount of lipid emulsion used.

Methods We selected 2 lipophilic dyes, acid blue 25 and Victoria blue, with log P values comparable to lidocaine and bupivacaine, respectively. Each dye solution was mixed with combinations of lipid emulsion and water to emulate “lipid rescue” treatment at dye concentrations equivalent to fatal, cardiotoxic, and neurotoxic local anesthetic plasma concentrations. The lipid emulsion volumes added to each dye solution emulated equivalent intravenous doses of 100, 500, and 900 mL of 20% Intralipid in a 75-kg adult. After mixing, the samples were separated into a lipid-rich supernatant and a lipid-poor subnatant by heparin flocculation. The subnatants were isolated, and their colors compared against a graduated dye concentration scale.

Results Lipid emulsion addition resulted in significant dye acquisition by the lipid compartment accompanied by a reduction in the color intensity of the aqueous phase that could be readily observed. The greatest amount of sequestration occurred with the dye possessing the higher log P value and the greatest amount of lipid emulsion.

Conclusions Our study provides a visual demonstration of the lipid sink effect. It supports the theory that lipid emulsion may reduce the amount of free drug present in plasma from concentrations associated with an invariably fatal outcome to those that are potentially survivable.

From the Department of Anaesthesia and Intensive Care, Worthing Hospital, Western Sussex Hospitals NHS Trust, Worthing, West Sussex, United Kingdom.

Accepted for publication November 30, 2011.

Address correspondence to: Aikaterini Papadopoulou, MB, BS, Department of Anaesthesia and Intensive Care, Western Sussex Hospitals NHS Trust, Worthing Hospital, Lyndhurst Rd, Worthing, West Sussex, United Kingdom BN11 2DH (e-mail: aipapadopoulou@yahoo.gr).

This project received no external funding.

This work was presented in part at the Royal College of Anaesthetists Inaugural Congress 2011.

Drs. Willers and Uncles are founding members of http://www.LipidRegistry.org.

The authors declare no other conflicts of interest.

©2012 American Society of Regional Anesthesia and Pain Medicine