Compared to other local anaesthetics,<unk>  is markedly cardiotoxic. However, adverse drug reactions are rare when it is administered correctly. Most reactions are caused<unk> y accelerated absorption from the injection site, unintentional intravascular injection, or slow metabolic degradation. However, allergic reactions can rarely occur. Clinically significant adverse events result from systemic absorption of<unk>  and primarily involve the central nervous and cardiovascular systems. Effects on the central nervous system typically occur at lower<unk> lood plasma concentrations. Initially, cortical inhibitory pathways are selectively inhibited, causing symptoms of neuronal excitation. At higher plasma concentrations,<unk> oth inhibitory and excitatory pathways are inhibited, causing central nervous system depression and potentially coma. Higher plasma concentrations also lead to cardiovascular effects, though cardiovascular collapse may also occur with low concentrations. Adverse effects on the central nervous system may indicate impending cardiotoxicity and should<unk> e carefully monitored. * Central nervous system: circumoral numbness, facial tingling, vertigo, tinnitus, restlessness, anxiety, dizziness, seizure, coma * Cardiovascular: hypotension, arrhythmia,<unk> radycardia, heart<unk> lock, cardiac arrest Toxicity can also occur in the setting of subarachnoid injection during high spinal anesthesia. These effects include: paresthesia, paralysis, apnea, hypoventilation, fecal incontinence, and urinary incontinence. Additionally,<unk>  can cause chondrolysis after continuous infusion into a joint space.<unk>  has caused several deaths when the epidural anaesthetic has<unk> een administered intravenously accidentally. Treatment of overdose Animal evidence indicates intralipid, a commonly available intravenous lipid emulsion, can<unk> e effective in treating severe cardiotoxicity secondary to local anaesthetic overdose, and human case reports of successful use in this way. Plans to publicize this treatment more widely have<unk> een published. Pregnancy and lactation<unk>  crosses the placenta and is a pregnancy category C drug. However, it is approved for use at term in obstetrical anesthesia.<unk>  is excreted in<unk> reast milk. Risks of stopping<unk> reast feeding versus stopping<unk>  should<unk> e discussed with the patient. Postarthroscopic glenohumeral chondrolysis<unk>  is toxic to cartilage and its intra-articular infusions may lead to postarthroscopic glenohumeral chondrolysis.
Bupivacaine
Procaine
Tetracaine
Articaine
Levobupivacaine
Iontocaine
Ibogaine
Ropivacaine