SynthesisJournal of medical toxicology : official journal of the American College of Medical Toxicology2026
Systematic Review and Meta-Analysis of Lipid Emulsion for Non-Local Anesthetic Poisoning.
Synthesis in Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
introductionPractitioners routinely use intravenous lipid emulsion for local anesthetic systemic toxicity, but its role in non-local anesthetic poisonings remains unclear. We conducted a systematic review and meta-analysis comparing lipid emulsion with standard care for non-local anesthetic toxicities.
methodsWe searched PubMed, Embase, Scopus and Web of Science from January 1st 2010 until March 16th 2026 for human randomized controlled trials evaluating lipid emulsion for non-local anesthetic poisoning. Volunteer studies and pediatric-only studies were excluded. The primary outcome was intensive care unit admission (with intubation as a surrogate for unit-level needs). Secondary outcomes included mortality, seizures, and hospital length of admission. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random-effect meta-analysis was conducted. Heterogeneity was analyzed using Cochran's Q and I
resultsTwelve studies with 816 patients were included, predominantly using 20% SMOFlipid® 280 - 500 mL. Lipid emulsion reduced intensive care unit admission compared to standard care (RR=0.70; 95% CI: [0.53, 0.93], 8 studies, n=369) with moderate heterogeneity (Q=9.43, p=0.02; I DISCUSSION: Intravenous lipid emulsion is associated with reduced intensive care unit admission and mortality for aluminum phosphide and organophosphate poisonings and a reduced length of admission for aluminum phosphide, organophosphate, and antipsychotic poisonings. The evidence is limited by study heterogeneity and study quality. Larger, high-quality trials are needed to confirm benefit. REGISTRATION NUMBER: CRD42025645519.
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