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Bupivacaine and L-carnitine deficiency!



Ventricular arrhythmias and cardiac arrest have been reported with the use of bupivacaine and patients with L- carnitine deficiency. These complications occurred with blood levels of bupivacaine that were not in the toxic range. In experimental animals this susceptibility was reversed with supplementation of L- carnitine. 


References
1. Wong GK, Crawford MW. Carnitine deficiency increases susceptibility to bupivacaine-induced cardiotoxicity in rats. Anesthesiology 2011; 114: 1417-24
2. Weinberg GL, Palmer JW, VadeBoncouer TR et al. Bupivacaine inhibits acylcarnitine exchange in cardiac mitochondria. Anesthesiology 2000; 92:523-8
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