Some factors have been identified as contributing to medical errors, such as labels, appearance and location of ampoules. We present a case of accidental injection of tranexamic acid instead of Bupivacaine during spinal anaesthesia. One minute after the injection of 3 mL of the solution, the patient developed myoclonus of her lower extremities. Accidental intrathecal injection of the wrong drug was suspected and a used ampoule of tranexamic acid was discovered in the trash can. The ampoules of Bupivacaine (5 mg/mL, trade name “Sensovac Heavy”) and tranexamic acid (500 mg/mL, Trade name “Nexamin”) were similar in appearance. Her myoclonus was successfully treated with phenytoin, sodium valproate, thiopental sodium infusion, midazolam infusion and supportive care of haemodynamic and respiratory systems. The surgery was temporarily deferred. The patient's condition progressively improved to full recovery.
Adequate intravascular volume maintenance is essential to ensure early graft function during renal transplantation. Various recommendations on optimum fluid therapy are based, at best, on sparse evidence, and that too only from observational studies. This prospective randomized controlled study was done to evaluate the effect of 20% human albumin on the early graft function in living donor renal transplantation. Eighty patients undergoing renal transplantation were randomly assigned to one of the intraoperative fluid regimens, 0.9% normal saline with 20% human albumin (albumin group) or 0.9% normal saline alone (saline group), after confirming the exclusion criteria. Intravenous fluid infusion was given to keep central venous pressure (CVP) between 12 to 15 mm Hg. The statistical package of social sciences, SPSS version 12, was used for statistical analysis. The intraoperative fluid volume infused [albumin group--3381±1021.2 vs. saline group--3487±978.5 (mL)] to maintain target CVP was comparable between the two groups (P value>0.05). Statistically, no significant difference was found between the two groups in terms of post transplant serum creatinine [day one; 2.76±1.0 vs. 2.58±0.94, day three; 1.48±0.53 vs. 1.43±0.71, day seven; 1.42±0.6 vs. 1.42±0.53 (mg/dL)] and urine output [day one; 13122.5±5767.8 vs. 13909.4±5324.7, day three; 9233.9±3267.4 vs. 9250±4794.2, day seven; 7517.6±3043.6 vs. 6921.4±3170 (mL)] (P value>0.05). Postoperative change in body weight [1.89±3.82 vs. 2.48±3.89 (kg)], tissue edema (10% vs. 7.5%), and pulmonary edema (2.5% vs. 5%) did not differ significantly (P>0.05). Twenty percent human albumin given intraoperatively, as a volume expander, does not improve early graft function in living donor renal transplantation. It should be used selectively rather than as a routine protocol.
Adults with congenital heart disease are increasing due to improvement in infant heart surgery and availability of better cardiac care. Pregnancy in these patients requires multidisciplinary team approach due to circulatory changes. We describe an anesthetic management of the parturient undergoing cesarean section having severe pulmonary restenosis.
A 57-year-old, male patient (165 cm, 66 kg) was scheduled to undergo right radical nephrectomy for renal cell carcinoma. Clinical history, physical examinations and laboratory investigations of the patient were normal. After placing the patient in right lateral position, epidural space was identified at first attempt with 18G Tuohy needle (BD Perisafe, Belgium) via a midline approach at L2-L3 intervertebral space using loss of resistance to air technique. A 20G multiorifice epidural catheter was threaded through the cranially directed tip of epidural needle to the 15 cm mark. The needle was removed and the catheter was left 6 cm into the epidural space. Patient did not complain of pain or paraesthesia during the procedure. Because of paucity of time both epidural test dose (3 ml of 2% lignocaine with 1:200000 epinephrine) and analgesia was given after induction of general anaesthesia. After pre-medication with fentanyl 100 μg intravenous (IV), the patient was given balanced general anaesthesia. Induction was performed with propofol 150 mg IV and atracurium 35 mg IV was given to facilitate endotracheal intubation and was maintained with isoflurane 0.2% -0.8% in an oxygen-nitrous oxide mixture at a 1:1 ratio. After induction, 0.25% bupivacaine 10 ml was given through epidural catheter without having any effect on haemodynamics. Surgery proceeded via right subcostal incision with the patient in the supine position. The right kidney was removed and near the end of surgery, when the surgeon was examining the renal bed, the distal portion of the epidural catheter was seen. The catheter was lying parallel to the inferior vena cava in front of psoas major muscle at the L1-L2 level [Table/ Fig-1]. Retrograde dissection revealed the catheter emerging from the anterior vertebral fascia at the L2-L3 level. Further confirmation was done by flushing the catheter with the normal saline which was coming out of the multiorifice at the distal end of the catheter. Catheter was removed and intravenous tramadol was used for postoperative pain management. DISCUSSIONCritical incident reporting is a valuable part of quality assurance. Identifying and mitigating risk factors associated with patient harm can improve patient safety [1]. Though various imaging studies and direct evidence case reports of epidural catheter misplacement in different regions of vertebral column have been reported, only one case of direct visible evidence of transforaminal escape of lumbar epidural catheter has been reported to our knowledge [2].Due to lack of uniform outcome measures, incidence of failure of epidural anaesthesia and analgesia ranges from 13% to as high as 47% [3]. Factors that influence the technical failure of epidural anaesthesia and analgesia are, anatomical catheter location, patient position, puncture site, midline versus paramedian approach, methods to localize epidural space, catheter insertion and fixation and equipment related problems.Three cases of misplaced epidural catheter into the thoracic cavity found during surgery have been r...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.