Inadvertent intraarterial injection of thiopentone

Abstract

A case is recorded in which intra-arterial injection of thiopentone 2.5 per cent was made into an aberrant branch of the radial artery at the lateral aspect of the wrist. Although the intra-arterial injection of thiopentone is a fairly uncommon accident, especially on the dorsum of the hand, nevertheless, precautions should always be taken to avoid it. These precautions should include palpating for a pulse before application of a tourniquet and after removal of the tourniquet, and checking for backflow of blood after insertion of the cannula. The anaesthetist should always have a high index of suspicion, should use a vessel which is significantly remote from any palpable pulse and should always pause after a test dose of one or two ml of thiopentone solution to ensure that the injection is not uncomfortable. Some of the anatomical abnormalities to be found in the arterial supply to the forearm and hand have been described, and the immediate and late treatment of accidental arterial injection of thiopentone has also been detailed.

Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies

“…Although the clinical syndrome of IA injections is well defined, the underlying pathophysiologic mechanism remains unclear. Many mechanisms have been proposed and [15][16][17][18][19] Phlebitis, vascular impairment Amputation Midazolam 38 No initial symptoms, later symptoms resolved None necessary without sequelae Temazepam (case series of Histological: myocyte necrosis, interstitial edema, Fasciotomies, amputations 9 patients) 39 arterial and venous thrombosis, vasculitis, endothelial denudation Clinical: compartment syndrome, rhabdomyolysis, gangrene Chlordiazepoxide 26 Forced wrist flexion, pulselessness, decreased IA papaverine injection, full recovery sensation Phenothiazines Promethazine 40,41 Gangrene Sympathetic block, heparinization Chlorpromazine 42 Gangrene NR Promazine 32, 41,43,44 Gangrene NR Barbiturates Thiopental 3,[21][22][23][24][25][27][28][29][30][31][32][33][34]37,[45][46][47] Chemical endarteritis, immediate vasoconstriction, Procaine injection into artery, stellate ganglion thrombosis, tissue necrosis, endothelial cell block, early anticoagulant therapy (heparin), destruction (on histological analysis), tissue papaverine, phenoxybenzamine, IA urokinase, necrosis IA reserpine, tolazoline Thiopental (rabbit ear model) 48 Necrosis Methimazole, aspirin, aloe vera, methylprednisolone Quinalbarbitone 11,12,28 Gangrene NR Secobarbital 12,36…”

Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies

“…Although the clinical syndrome of IA injections is well defined, the underlying pathophysiologic mechanism remains unclear. Many mechanisms have been proposed and [15][16][17][18][19] Phlebitis, vascular impairment Amputation Midazolam 38 No initial symptoms, later symptoms resolved None necessary without sequelae Temazepam (case series of Histological: myocyte necrosis, interstitial edema, Fasciotomies, amputations 9 patients) 39 arterial and venous thrombosis, vasculitis, endothelial denudation Clinical: compartment syndrome, rhabdomyolysis, gangrene Chlordiazepoxide 26 Forced wrist flexion, pulselessness, decreased IA papaverine injection, full recovery sensation Phenothiazines Promethazine 40,41 Gangrene Sympathetic block, heparinization Chlorpromazine 42 Gangrene NR Promazine 32, 41,43,44 Gangrene NR Barbiturates Thiopental 3,[21][22][23][24][25][27][28][29][30][31][32][33][34]37,[45][46][47] Chemical endarteritis, immediate vasoconstriction, Procaine injection into artery, stellate ganglion thrombosis, tissue necrosis, endothelial cell block, early anticoagulant therapy (heparin), destruction (on histological analysis), tissue papaverine, phenoxybenzamine, IA urokinase, necrosis IA reserpine, tolazoline Thiopental (rabbit ear model) 48 Necrosis Methimazole, aspirin, aloe vera, methylprednisolone Quinalbarbitone 11,12,28 Gangrene NR Secobarbital 12,36…”