Anaes SAQs · Local anaesthetic pharmacology
Bupivacaine cardiotoxicity and the development of lipid rescue
The bupivacaine-toxicity SAQ — the tight cardiac Na+ channel binding, the slow dissociation (use-dependent trapping), the R-enantiomer as the culprit, the S-enantiomer alternatives (ropivacaine/levobupivacaine), and the lipid-sink + metabolic-substrate mechanism of rescue.
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Prompt
Explain why bupivacaine is uniquely cardiotoxic among the local anaesthetics, how this led to the development of ropivacaine and levobupivacaine, and the mechanism by which lipid emulsion reverses the toxicity.
Question
Explain why bupivacaine is uniquely cardiotoxic among the local anaesthetics, how this led to the development of ropivacaine and levobupivacaine, and the mechanism by which lipid emulsion reverses the toxicity.
References3ShowHide
- [2]Fettiplace MR, Weinberg G. The Mechanisms Underlying Lipid Resuscitation Therapy. Regional Anesthesia and Pain Medicine, 2018.PMID 29356774
- [3]McAllister RK, Patel P. Bupivacaine. StatPearls, 2026.PMID 30422478
- [4]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.