A review of local anesthetic cardiotoxicity and treatment with lipid emulsion

Emma Bourne¹, Christine Wright¹, Colin Royse²

¹Cardiovascular Therapeutics Unit, Department of Pharmacology, University of Melbourne; ²Anesthesia and Pain Management Unit, Department of Pharmacology, University of Melbourne

Abstract: Cardiovascular collapse from accidental local anesthetic toxicity is a rare but catastrophic complication of regional anesthesia. The long-acting amide local anesthetics bupivacaine, levobupivacaine and ropivacaine have differential cardiac toxicity, but all are capable of causing death with accidental overdose. In recent times, the chance discovery that lipid emulsion may improve the chance of successful resuscitation has lead to recommendations that it should be available in every location where regional anesthesia is performed. This review will outline the mechanisms of local anesthetic toxicity and the rationale for lipid emulsion therapy.

Keywords: local anesthetic, cardiac toxicity, lipid emulsion, cardiovascular collapse