Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.

Corresponding Author: Solmaz Maleki Dizaj, Faculty of Pharmacy, Tabriz University of Medical Sciences, Golgasht Street, Daneshgah Ave., Tabriz, Iran, Tel: 98(41)33372250;E-Mail: [email protected]

Received Date: 04 Jul 2017 Accepted date: 12 Jul 2017    Published Date: 14 Jul 2017

Copyright  ©2017 Solmaz MD

Citation: Solmaz MD. (2017). The Role of Intralipid in the Heart Protection in Late Pregnancy. Mathews J Anesth. 1(2): 007.

 

ABSTRACT

The occurrence of coronary artery disease in females is growing owing to the alteration in lifestyle. Furthermore, the acute coronary syndrome will happen more through pregnancy when women delay pregnancy until an older age. In recent years, many applications of intralipids have efficaciously examined its use in critically ill patients. Some reports demonstrated that using intralipid has an important role in heart protection in late pregnancy. This brief review will summarize some main information about pregnancy-related coronary heart disease and the role of intralipid in heart protection in late pregnancy. Based on the reviewed literature, more trials are still essential to clarify the basic mechanism of intralipids regarding heart protection and any resulting new applications. As a result of the side effects of opiates, intravenous acetaminophen has been recently introduced for pain management, an issue that was previously controversial in clinical practice. We aim to explore its efficacy in acute pain control, pediatric and regional anesthesia.

KEYWORDS

Intralipid; Heart protection; Late Pregnancy.

INTRODUCTION

Heart diseases are one of the major causes for the death of millions of people every year. The risk factors influencing can be controlled and decreased. Indeed, managing of risk factors may convert them into protection factors. Hypercholesterolemia, hypertension, and cigarette smoking are three main factors that, if controlled, can improve the patient condition. Studies show that even patients with asymptomatic cardiovascular disease have profited from aggressive cholesterol-lowering therapy. Controlling hypertensive disease by new guidelines can also be improved [1-4]. Furthermore, according to reports, former smokers have shown less risk of myocardial infarction compared to smoker persons [2, 5].

Coronary heart disease as the main health problem happens three- to four times more often in pregnant women as compared with the non-pregnant women in this age group owing to major changes in women's lifestyle forms (pregnancy age, stress, smoking, diabetes, and chronic hypertension). Such a situation during pregnancy can present a major risk. Indeed, the changes in the general conditions during pregnancy like the cardiac, hemodynamic, hemostatic and hormonal situations lead to the increased death rate among pregnant women with coronary heart disease. Therefore, diagnosis and heart protection are necessary during pregnancy [3, 6, 7]. Since the prevalence of coronary artery disease in late pregnancy (LP) has increased recently, the selection of diagnostic and therapeutic methodologies is crucial for maternal and fetal safety.

Intravenous lipid emulsion (ILE) is a new method to treat local anesthetic systemic toxicity (LAST) as well as an effective antidote for other lipophilic drug poisonings. This emulsion-based material is comprised of soybean oil, egg phospholipids, and glycerin. It is available in three concentrations: 10%, 20%, and 30%, yet the latter concentration has not been accepted for direct intravenous infusion [8, 9]. Recently, various applications of ILE have efficaciously been investigated in critically ill patients. This emulsion-based material known as intralipid has been used as a key source of essential fatty acids for parenteral nutrition. Numerous studies have been done to identify the mechanism of this new treatment [7, 10, 11]. In recent reports, some applications of intravenous lipid emulsion therapy have evolved as a treatment for local anesthetic toxicity. Other applications of intralipid such as ability in heart protection have also appeared in recent years. Moreover, this emulsion-based therapy has been applied in other areas such as in cancer therapy area or as treating unexplained recurrent spontaneous abortion [5, 8, 9, 12].

This review will summarize the available information about pregnancy-related coronary heart disease and also the role of intralipid in heart protection in late pregnancy.

Pregnancy-Related Coronary Heart Disease According to WHO, nearly 99% of universal maternal deaths related to pregnancy problems happen in low-income and middle-income countries [13]. Heart disease as a major health problem is reported to be 3-4 times more in pregnant women as compared with the non-pregnant women in the same age group. Some women won't recognize they have bad heart situations until complications arise. Heart attacks are one of the major reasons for maternal death in the developing world. The occurrence of coronary artery disease in late pregnancy (LP) has increased in recent years triggering the introduction of new diagnostic and therapeutic modalities to ensure fetal and maternal safety [2, 6, 7].

Postpartum cardiomyopathy or peripartum cardiomyopathy is a rare form of heart failure that may happen in the last month of pregnancy. Its signs include tiredness, shortness of breath, swollen ankles, swollen neck veins, and feeling of missed heartbeats or palpitations. Pre-eclampsia is another problem affects up to six percent of women in LP. Its symptoms include high blood pressure as well as the occurrence of protein in the urine. Coronary artery dissection occurs when inner layers of a coronary artery tear away from the outer layer resulting in a heart attack. Eighty percent of patients suffering from coronary artery dissection are women, and 30 percent of them reported to be in LP [14].

The Role of Intralipid in Pregnancy Reports show that the occurrence of heart disease in LP has increased lately owing to some important changes in women's lifestyle patterns. These reports have also revealed that myocardial infarction during LP and the peripartum is related to high maternal mortality and morbidity compared to nonpregnant women. Some rare studies have focused on the role of intralipid in heart protection in late pregnancy. However, some investigators have presented their study results in this regard. For example, Li et al proved that the heart of LP rodents is more prone to ischemia/reperfusion (I/R) injury compared to non-pregnant rodents. In their study, In-vivo female LP rat hearts or ex-vivo isolated Langendorff-perfused LP mouse hearts were subjected to ischemia followed by reperfusion. Their results showed that using in tralipid significantly reduced the in-vivo myocardial infarct size in LP rats and also protected the LP hearts against I/R injury ex-vivo. According to authors, a specific inhibitor of STAT3 known as Stattic cause to intrepid-induced cardioprotection. Their analysis also showed that caveolin 2 (Cav2) was significantly upregulated by intrepid in the hearts of LP rats under I/R injury. Their other experiments revealed that Cav2 interacts with STAT3. Then, intrepid protects the heart in LP against I/R injury by inhibiting the mPTP opening through Cav2/STAT3/ GSK-3β pathway [15]. The molecular mechanisms related to intrepid-induced cardioprotection in LP is not yet very clear. Li et al hypothesized that intrepid may protect the heart in LP by regulating the levels of specific microRNAs. They also verified that cardiac vulnerability to I/R injury extremely increases in LP rodents. This process leads to myocardial infarct size ~4 fold larger than in non-pregnant rodents. According to the authors, the administration of intralipid at reperfusion causes an infarct size reduction in LP rat subjected to I/R injury [16]. According to their MicroRNA-microarray analysis, the expression of MiR122 was outstandingly upregulated more than 10 fold in the heart of LP rats in the intralipid group compared to the control group. Their analysis showed that miR122 regulates apoptosis in cardiomyocytes subjected to hypoxia/reoxygenation since miR122-overexpression resulted in reduced apoptosis, whereas knockdown of miR122 increased apoptosis. Data showed that Pyruvate kinase isoform M2 (PKM2) and caspase 3 are two targets of miR122 since the expression of PKM2 and capase-3 in the hearts subjected to I/R was meaningfully lower in the intralipid group compared to control group in LP [16].

CONCLUSION

Intralipids are a source of calories have been used for years, however, there are rare reports about rescuing effects in heart disease and the role of intralipid in heart protection in late pregnancy. Therefore, more trials are vital to explain the basic mechanism of intralipids concerning heart protection and subsequent novel applications.

CONFLICTS OF INTEREST

The author declares no conflict of interest.

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