Intralipid

 Maximum dose of lidocaine (plain, without vasoconstrictor)  is 4.5 mg/kg (not to exceed 300 mg) and similarly for Bupivacaine it's 2.5 mg /kg not to exceed 175 mg in a single dose. These figures could be read in almost all the standard text books of Anaesthesiology. But interestingly, nowhere it's written what's the safe dose of each of them when they're mixed together. As we're aware we always mix these two drugs when we give blocks. Wonder why no author has ever bothered to write about the safe dose when they're mixed. Accidental intravascular injection is the major cause of systemic toxicity, for example, regional anesthesia of the neck (interscalene block ) can cause direct intra-arterial injection and cause rapid toxicity from early entry to the cerebral circulation. Epidural anesthesia holds a risk of intravenous injection into the engorged epidural venous plexus of the parturient. The accidental overdose of local anaesthetics may prove fatal. Over the last decade, there has been convincing evidence of intravenous lipid emulsions as a rescue in local anaesthetic for  cardiotoxicity. Hence I would request all  Anaesthesiologists to keep intralipid always available in the operation theatre fridge. Col Pradeep Pendyala.