Lipid emulsion treatment for ventricular tachycardia induced by the toxicity of multiple herbs

Abstract

A toxic dose of bupivacaine, a highly lipid-soluble amino-amide local anesthetic, causes conduction block and myocardial depression via the inhibition of cardiac sodium, potassium, and calcium channels, leading to QRS widening, ventricular tachyarrhythmia, and cardiac arrest. Although the “lipid sink theory” was initially one of the most widely accepted mechanisms explaining the effects of lipid emulsion treatment, the “lipid shuttle” concept, which states that the lipid phase of a lipid emulsion absorbs highly lipid-soluble local anesthetics such as bupivacaine from the heart, is now widely considered to be an indirect mechanism underlying the effect of lipid emulsion treatment.