Q: What is the dose of lipid emulsion in lidocaine toxicity?


 Answer: Lipid emulsion is suggested for lidocaine or local anesthetic toxicity particularly with cardiac arrhythmia or asystole.  It is a 1.5-mL/kg bolus of 20% lipid emulsion solution, followed by a 0.25-mL/kg per minute infusion for 30 to 60 minutes. The bolus can be repeated 1 to 2 times for continued symptoms.

Modus operandi is via "lipid sink". As lidocaine is lipid-soluble, it may reduce the overall plasma concentration. Another mechanism suggested is fostering of cardiac metabolism by augmenting the fatty acid supply, promoting aerobic metabolism and reducing acidosis,


References: 

1. Mazoit JX, Le Guen R, Beloeil H, Benhamou D. Binding of long-lasting local anesthetics to lipid emulsions. Anesthesiology. 2009;110(2): 380-386. 

2. Weinberg GL. Lipid infusion therapy: translation to clinical practice. Anesth Analg. 2008 May. 106(5):1340-2