Local anesthetics work through reversible binding of sodium channels
If inadvertantly administered intravenously or as an overdose, serious CNS and cardiac toxicities can occur, including seizures, arrhythmias, and cardiovascular collapse
Fat emulsion has been shown to increase the lethal dose of bupivicaine required, and also resuscitate animals that have local-anesthetic induced cardiac collapse
There have beensuccessful case reports of patiets treated with fat emulsion that had cardiac arrest, seizures, and EKG changes. All patients recovered successfully with no neurologic sequale
Regimens used in these cases have included bolus doses between 1.2 -2 ml/kg followed by continuous infusions of 0.25 -0.5 ml/kg/min
Toxicity may be ameloriated by extracting lipophilic anesthetics from plasma or tissue, or by countering inhibition of myocardial fatty acid oxygenation
