Which local anesthetic is particularly associated with cardiotoxicity?

Bupivacaine is well-known for its potential to cause cardiotoxicity, particularly when used in higher doses or in cases of unintentional intravascular injection. This local anesthetic has unique properties that allow it to block sodium channels more effectively, leading to prolonged effects and a higher risk of cardiovascular complications compared to other agents.

Cardiotoxicity may manifest as arrhythmias, decreased cardiac output, or, in severe cases, cardiac arrest. Understanding the pharmacological profile of bupivacaine helps clinicians weigh the risks and benefits when choosing an anesthetic for a given procedure, especially in a patient with existing cardiovascular concerns.

Lidocaine, chloroprocaine, and procaine do not carry the same levels of risk in terms of cardiotoxicity as bupivacaine, which solidifies bupivacaine's association with such adverse effects.