Mechanism of myocardial toxicity induced by bupivacaine

Bupivacaine has become a widely used local anesthetic, but exhibits a strong tendency to cardiac toxicity when accidentally administered intravenously. Numerous animals studies aimed at elucidating the mechanism of bupivacaine’s cardiotoxicity focused on the direct inhibition of myocardial. However, recent studies have led to speculating that the cardiovascular toxicity of bupivacaine is mediated, at least in part, by drug actions within the central nervous system. It has been found that epinephrine, a β-adrenergic agonist, can not rescue or even exacerbate the cardiotoxicity of bupivacaine. Experiments are needed to explore further the underlying mechanism. Key words: Bupivacaine; Drug toxicity; Myocardium; Central nervous system; Epinephrine