Intralipid LAST — FRCA Primary MCQ

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ModeratePharmacology - AnalgesicsIntralipid LASTFRCA Primary

According to the Association of Anaesthetists Quick Reference Handbook, what dose of 20% Intralipid should be given as the initial intravenous bolus when treating severe local anaesthetic systemic toxicity?

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Correct answer: D — 1.5 mL/kg over 1 minute

The correct answer is D. For severe local anaesthetic systemic toxicity, the Association of Anaesthetists Quick Reference Handbook specifies an initial intravenous bolus of 20% Intralipid at 1.5 mL/kg over 1 minute. This is followed by an infusion at 15 mL/kg/hour. If cardiovascular stability is not restored or subsequently deteriorates, the same bolus may be repeated at 5 and 10 minutes, and the infusion rate may be doubled after 5 minutes. The maximum cumulative lipid-emulsion dose is 12 mL/kg. A dose of 0.5 mL/kg is inadequate, while initial boluses of 5, 10 or 20 mL/kg substantially exceed the recommended dose; 20 mL/kg also exceeds the entire permitted cumulative dose.

Reference: Association of Anaesthetists, Quick Reference Handbook: Guidelines for crises in anaesthesia, section 3-10 ‘Local anaesthetic toxicity’, August 2019 edition. https://www.rcoa.ac.uk/media/9386