Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremor, depression, or drowsiness may be early warning signs of CNS toxicity following local anesthetic injection. Local anesthetics associated with rare occurrences of sudden respiratory arrest. Convulsions due to systemic toxicity leading to cardiac arrest also reported, presumably following unintentional intravascular injection. Use with caution in the following situations, due to greater risk for toxicity: hypotension, hypovolemia, heart block, cardiovascular disease, hepatic impairment, neurological disorders, psychiatric disorders, acutely ill or debilitated patients. Use with caution in patients on type III antiarrhythmics (e.g. amiodarone), since cardiac effects may be additive. I.V. injections should be avoided. Ropivacaine not recommended for use in emergency situations where rapid administration is necessary.