Local Anesthetic Cardiac Toxicity is Mediated by Cardiomyocyte Calcium Dynamics

( Anesthesiology 2022;137:687–703) Local anesthetic (LA) has valuable perioperative indications but can also pose cardiac risks to patients when used in high doses. One of these risks is cardiotoxicity, including arrhythmias and contractile depression. Cardiotoxicity can also lead to cardiac arrest, which may be fatal. The mechanism of many local anesthetics is sodium channel blockade; if administered incorrectly or if there is spread beyond the target area, cardiotoxicity can be induced via myocardial sodium channel interruption. The purpose of this study was to understand the risk of LA-induced cardiotoxicity and improve clinical recommendations using human-induced pluripotent stem cell-derived cardiomyocytes to supplement animal data. The authors hypothesized that bupivacaine and ropivacaine disrupt normal calcium dynamics in opposite ways, supporting previous data in vivo. Researchers evaluated the effects of both bupivacaine and ropivacaine on heart contractions and arrhythmias in a rat model and contrasted the effects of calcium supplementation.