Editing Local anesthetic (section)

==== Cardiovascular system ====

Cardiac toxicity can result from improper injection of agent into a vessel. Even with proper administration, it is inevitable for some diffusion of agent into the body from the site of application due to unforeseeable anatomical idiosyncrasies of the patient.<ref name=":2" />  This may affect the nervous system or cause the agent to enter into general circulation. However, infections are very seldom transmitted.

Cardiac toxicity associated with overdose of intravascular injection of local anesthetic is characterized by [[hypotension]], [[Atrioventricular node|atrioventricular]] conduction delay, [[Idioventricular rhythm|idioventricular]] rhythms, and eventual cardiovascular collapse. Although all local anesthetics potentially shorten the myocardial refractory period, [[bupivacaine]] blocks the cardiac sodium channels, thereby making it most likely to precipitate malignant [[Heart arrhythmia|arrhythmias]]. Even [[levobupivacaine]] and [[ropivacaine]] (single-enantiomer derivatives), developed to ameliorate cardiovascular side effects, still harbor the potential to disrupt cardiac function.<ref>{{cite journal | vauthors = Stiles P, Prielipp RC |title=Intralipid Treatment Of Bupicavaine Toxicity |journal=Anesthesia Patient Safety Foundation |date=Spring 2009 |volume=24 | issue = 1 |url=http://www.apsf.org/newsletters/html/2009/spring/12_Intralipid.htm |access-date=12 June 2013}}</ref> Toxicity from anesthetic combinations is additive.<ref name=":2" />