Facharzt FMH Anästhesiologie Practice Questions - Facharzt FMH Für Anästhesiologie Spécialiste FMH En Anesthésiologie Specialista FMH In Anestesiologia Exam

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A 32-year-old patient undergoing knee arthroscopy receives an ultrasound-guided femoral nerve block with 20 mL of 0.5% bupivacaine. Five minutes after injection, the patient develops perioral numbness, metallic taste, sudden generalized tonic-clonic seizures, and wide-complex ventricular tachycardia. Which molecular mechanism explains the heightened cardiotoxicity of bupivacaine compared to lidocaine?

Selective blockade of L-type calcium channels without affecting myocardial sodium conduction Rapid dissociation from open voltage-gated potassium channels during the cardiac action potential Selective agonism of central alpha-2 adrenoceptors causing massive sympathetic outflow Slow dissociation kinetics from cardiac voltage-gated sodium channels during diastole ('fast-in, slow-out')

Correct Answer:

Slow dissociation kinetics from cardiac voltage-gated sodium channels during diastole ('fast-in, slow-out')

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