It’s not propofol. This milky-white substance is Intralipid solution. There are plenty of uses for intralipid infusions in medicine; for the purpose of this blog, take note that we are discussing the 20% solution.
1) So why do you need it?
For reversal of local anesthetic-induced systemic toxicity (aka “LAST”) manifested as either: cardiac arrest that is refractory to standard ACLS therapy, or neurotoxicity manifested as status epilipticus.
It’s use has also been suggested in algorithms for reversal of cardiotoxicity caused by numerous other lipophilic drugs, such as TCAs and beta-blockers. However, the optimal administration and dosage recommendations for use in PO ingestions are not clear yet... so keep your ears open!
2) How does it work?
Proposed mechanism for reversal of anesthetic-induced toxicity: well, it’s again not quite clear, but the term “lipid sink” is thrown around quite a bit (see links at bottom of page for more info).
Somewhat easier to figure out is how to give it. As a general rule, for a 70 kg adult in cardiac arrest:
Give a 70 mL bolus over 1 minute. Wait 3 minutes. Repeat x 2 if no response to initial bolus (hopefully by now you’ve achieved ROSC). Then hang the bag and give the remainder as an infusion over 15 minutes.
The suggested max dose is 8mL/kg, which for a 70 kg adult is conveniently just over the size of a 500ml container in which it is usually packaged.
Want to learn more?
http://rebelem.com/local-anesthetic-systemic-toxicity-last/
http://www.thepoisonreview.com/2015/06/09/how-lipid-rescue-therapy-works-its-more-than-just-a-sink/
https://www.ncbi.nlm.nih.gov/pubmed/19845549