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Local anaesthetic cardiotoxicity — FRCA Primary MCQ

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ModeratePharmacologyLocal anaesthetic cardiotoxicityFRCA Primary

A patient develops seizures and broad-complex arrhythmia after accidental intravascular injection during a regional block. Which drug is the most likely cause?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Bupivacaine

Bupivacaine is the amide local anaesthetic classically associated with severe cardiotoxicity. Amiodarone is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Sevoflurane is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Noradrenaline is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Ephedrine is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. In Primary FRCA pharmacology, link the clinical effect to the receptor, distribution or elimination mechanism rather than memorising isolated facts.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care; BNF; Primary FRCA textbooks