Ventricular fibrillation after accidental injection of bupivacaine into the pericardium.

A postoperative cardiac surgical patient developed ventricular fibrillation immediately after accidental pericardial injection of bupivacaine at room temperature. The possible causes, which include systemic toxicity, local vasoconstriction with myocardial ischaemia, local toxic effect of bupivacaine or local hypothermia, are discussed.