The Possible Mechanisms Underlying Epinephrine Worsens Bupivacaine Induced Cardiac Toxicity

Abstract

Overdose bupivacaine disturbs both electrophysiologic and hemodynamic function by blocking Na channels, affecting Ca transient and reuptake, inhibiting mitochondria respiration and lipid metabolism. Adrenergic activation aggravates Ca overload, increases oxygen consumption, increases ROS production, and therefore worsens cardiac contractile dysfunction.