Which of the following local anesthetics can cause cardiotoxicity in high doses?

Bupivacaine is known for its potential to cause cardiotoxicity, particularly when administered in high doses. This local anesthetic has a long duration of action and a higher affinity for binding to sodium channels compared to other local anesthetics. When used in elevated concentrations or inadvertently injected into the vascular system, bupivacaine can lead to serious cardiac effects, including arrhythmias and cardiovascular collapse.

This cardiac toxicity is attributed to its potency and lipid solubility, which allows it to remain in circulation longer and exert effects on the heart and vascular system. The other local anesthetics listed generally have a safer profile in terms of cardiotoxicity, especially when adhering to recommended dosages. Understanding the risks associated with high doses of local anesthetics is crucial for safe dental practice and minimizing adverse effects on patient health.