What is the typical initial bolus for lipid emulsion in local anaesthetic toxicity?

The typical initial bolus for lipid emulsion in cases of local anaesthetic toxicity is 1.5 ml/kg. This dosing is established based on clinical practice guidelines aimed at effectively counteracting the cardiovascular effects of local anaesthetic overdose.

Lipid emulsion therapy acts as a "lipid sink," which means it can sequester the lipophilic local anaesthetics and reduce their availability for tissue uptake and systemic circulation, ultimately mitigating toxicity. Administering the initial bolus at this specified level provides a substantial amount of lipid to address the potential signs of toxicity quickly and efficiently.

Subsequent to the initial bolus, the protocol typically suggests that this can be followed by continuous infusion if needed, but the initial 1.5 ml/kg dose is critical in providing an effective immediate response in emergency situations where local anaesthetic toxicity has occurred. This approach is well-supported by research and expert consensus in resuscitation guidelines, making it an essential part of managing severe cases of local anaesthetic overdose.