Case Report: Dynamic characteristics of myocardial depression after severe bupivacaine-induced local anesthetic systemic toxicity.

CASE PRESENTATION: A 32-year-old woman at term underwent combined spinal-epidural anesthesia.

Shortly after intrathecal administration of 2.0 mL of 0.5% bupivacaine, she developed sacrococcygeal numbness, limb tremors, and bilateral lower-limb convulsions, followed by rapid progression to severe circulatory collapse.

Bedside echocardiography revealed markedly impaired left ventricular systolic function, with a left ventricular ejection fraction (left ventricular ejection fraction) of approximately 27%.

Cardiac function then remained at a low-level plateau for the following several days and showed marked recovery approximately 120 h after onset, meeting the criteria for ECMO weaning.