Cardiovascular collapse from low dose bupivacaine.

Bupivacaine is a long-acting local anesthetic agent that is very widely used for cutaneous infiltration, peripheral nerve blocks, epidural anesthesia, and spinal anesthesia. Well-described cardiotoxic effects of bupivacaine and other members of its class include dysrhythmias, hypotension, and depression of cardiac output. The minimum IV dose of bupivacaine previously associated with significant toxicity in humans is 1.6 mg/kg. A case is reported of bradyasystolic arrest with post resuscitation shock, without significant central nervous system (CNS) toxicity, following the injection of less than 1.1 mg/kg bupivacaine in an adult.