title: Local anesthetic systemic toxicity: a historical perspective.
abstract: The most feared complication associated with the administration of local anesthetics is the profound and potentially lethal effect that these agents can have on cardiac conduction and function. This review traces the evolution of local anesthetic systemic toxicity beginning with the early deaths associated with the introduction of cocaine into clinical practice. The development of bupivacaine is discussed, with particular emphasis on the delayed recognition and acceptance of its inherent cardiotoxicity. Finally, the origins of lipid resuscitation are reviewed with respect to their theoretical foundation, as well as the confluence of events and experimental investigations that delivered this therapy into clinical practice.
authors.affiliation: University of California, San Francisco, CA 94110, USA. kdrasner@anesthesia.ucsf.edu
authors.forename: Kenneth
authors.initials: K
authors.lastname: Drasner
mesh_terms: D000779:Anesthetics, Local / Q000266:history / Q000506:poisoning*; D000818:Animals; D002045:Bupivacaine / Q000506:poisoning; D003042:Cocaine / Q000266:history / Q000506:poisoning; D006321:Heart / Q000187:drug effects*; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D008055:Lipids / Q000627:therapeutic use*; D011343:Procaine / Q000266:history / Q000506:poisoning
chemical_list: D000779:Anesthetics, Local; D008055:Lipids; D011343:Procaine; D003042:Cocaine; D002045:Bupivacaine