Bupivacaine toxicity treated with – a) Esmololb) Epinephrinec) Lignociained) 5 percent dextrosee) Benzodiazepines

Treatment of local anesthetic toxicity First step is to ensure adequate oxygenation, by face mask or intubation. LA infusion should be stopped immediately. Anticonvulsants like benzodiazepines (midazolanz) and barbiturates (thiopentone) are the drugs of choice for seizure control. Propofol can also be used. For hypotension, IV fluid and vasopressor agents may be used, e.g. epinephrine, dopamine, dobutamine or vasopressine. Epinephrine remains the drug of choice for circulatory collapse. For arrhythmias, amiodarone is the DOC. Bretylium and esmolol can also be used. Sodium bicarbonate can be given for metabolic acidosis. Patients with unresponsive bupivacaine toxicity, intrvenous lipid or cardiopulmonary bypass may be considered.