<prompt> Treatment of bupivacaine toxicity includes: PGI May 2011IsoprenalineCalcium channel blockersBretyliumMetoprolol  <response>: Ans: C Bretylium TREATMENT OF BUP1VACA1NE INDUCED CARDIOTOXIC1TY MILLER 6TH933Many resuscitation drugs, including atropine, epinephrine, bretylium, lidocaine, amrinone, and phenytoin, have been used in animal studies and occasionally in humans for the treatment of bupivacaine overdose and cardiovascular collapse. In our view, beyond the established uses of epinephrine, vasopressin, and atropine in their designated steps in the advanced cardiac life support ACLS protocol and beyond the use of Intralipid as detailed later, there is no established role for anti arrhythmic drugs or other traditional resuscitation drugs in the setting of bupivacaine-induced cardiac arrest It is not recommended that bupivacaine-induced ventricular arrhythmias be treated with iidocaine or amiodaroneThe clinical implications for cardiac resuscitation after intravascular injection or overdose of local anesthetic are the following: Miller 6th933No medications are uniformly effective in facilitating resuscitation from bupivacaine-induced cardiac arrest or severe ventricular tachycardia. Basic principles of cardiopulmonary resuscitation should be emphasized first, including attention to securing the airway; providing oxygenation and ventilation, and performing chest compressions if needed.Because resuscitation after local anesthetic-induced circulatory collapse is so difficult, prevention of massive intravascular injection or excessive dosing is crucial.Negative aspiration of the syringe does not always exclude intravascular placement, incremental, fractionated dosing should be the rule for all patients undergoing major conduction blockade. Although changes on the ECG are not always present before circulatory collapse, they often are, and continuous attention to the ECG including changes in QRS morphology, rate, rhythm, or ectopy may be lifesaving by terminating injection before a lethal dose is administered.If a patient experiences profound cardiovascular depression or circulatory arrest after the administration of bupivacaine, ropivacaine, or by extrapolation, other local anesthetics, then along with initiation of basic life support and theACLS protocol we support the recommendation of Weinberg and colleagues that a rapid bolus of Intralipid 20 