Accidental Subarachnoid Injection of Pancuronium

Peduto, V. A.; Gungui, P.; Martino, Mdv; Napoleone, Martha

doi:10.1097/00132582-199004000-00054

Cited by 3 publications

(4 citation statements)

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“…The accidental injection of small doses of gallamine or pancuronium into the CSF caused autonomic dysfunction and/or weakness in humans. [ 5 6 ] Our patient, however, showed no complications or adverse reactions. A metabolite of tracurium is laudanosine, which may contribute to seizure activity during an IV tracurium injection.…”

Section: Discussionmentioning

confidence: 64%

“…recommended that the intrathecal injection of hyperbaric 1% bupivacaine solution, a few minutes after the accidental injection of an NMB into the subarachnoid space, could limit the diffusion of the NMB. [ 6 ] However, this injection (tracurium) could be harmful, due to the length of time an NMB may stay in the CSF, which might prolong the neural effects. Tracurium degraded through Hoffman elimination, and so pH and heat were very important.…”

Section: Discussionmentioning

confidence: 99%

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Inadvertent intrathecal injection of atracurium

et al. 2011

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This report relates how tracurium was given by mistake, intrathecally, during spinal anesthesia, to a 38-year-old woman, who was a candidate for abdominal hysterectomy. When no analgesia was observed, the mistake in giving the injection was understood. She was evaluated postoperatively by train of four ratio, measuring her breathing rate, eye opening, and protruding of tongue at one, two, twenty-four, and forty-eight hours, and then at one and two weeks, with the final evaluation the following month. The patient had normal timings during the operation and postoperation periods, and no abnormal findings were observed through the first month. This finding was contrary to several studies, which described adverse reactions due to accidental intrathecal injection of neuromuscular blocking drugs.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Inadvertent intrathecal injection of atracurium

et al. 2011

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“…Neuromuscular blocking agents (NMBA) may be neurotoxic when reaching the central nervous system (CNS). Several case reports have indicated severe side‐effects such as autonomic dysfunction, prolonged neuromuscular blockade and seizure after accidental injection of gallamine or pancuronium directly into the subarachnoid space (1–3). Injection of atracurium, vecuronium or pancuronium into the CNS of rats dose‐dependently led to generalized seizures, but the relative potencies of the drugs in eliciting seizures had no relationship to their potencies as neuromuscular blocking drugs (4).…”

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confidence: 99%

“…Thus, while the underlying mechanism of the CNS effects of NMBA is still not fully understood, increasing evidence suggests that these substances may harm the brain (1–8). Under normal conditions these findings are probably not of clinical relevance, as NMBAs do not cross the intact blood‐brain barrier (BBB), but in patients with impaired function of the BBB these molecules may reach the CNS.…”

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confidence: 99%