ABSTRACT
Abstract Background: Inadvertent epidural drug administration is associated with morbidity and mortality. Several drugs have been administered accidentally through the epidural catheter and most of our knowledge is based on case reports. Case report: A 33 year-old woman presented for delivery. Placement of epidural catheter was requested for labor analgesia and priming dose was administered. Five minutes later, ampicillin 1 g was given through the catheter inadvertently without hemodynamic or neurological changes. Ropivacaine administration was repeated, always with symptomatic relief until delivery. At hospital discharge, she remained without neurological or hemodynamic alterations. Conclusions: The majority of errors are due to syringe and drug exchanges and inadvertent route administration. Erroneous administration into the epidural space can have immediate and late effects and there is no definitive and effective treatment. There are several preventive measures to reduce the potential complications; some opt for watchful waiting, others opt for administering other drugs as a dilution attempted.
Resumo Justificativa: A administração inadvertida peridural de drogas está associada à morbidade e mortalidade. Várias drogas foram administradas acidentalmente pelo cateter peridural e a maior parte do que sabemos se baseia em relatos de caso. Relato de caso: Uma gestante de 33 anos chegou em trabalho de parto. Foi solicitada colocação de cateter peridural para analgesia de parto e a dose inicial foi administrada. Cinco minutos depois, 1 g de ampicilina foi dado através do cateter inadvertidamente, sem alterações hemodinâmicas ou neurológicas. A administração de ropivacaína foi repetida, sempre com alívio dos sintomas até o parto. Na alta hospitalar, a paciente continuava sem alterações neurológicas ou hemodinâmicas. Conclusões: A maioria dos erros é por troca de seringa ou drogas, ou administração de rota inadvertida. A administração errônea no espaço peridural pode apresentar efeitos imediatos e tardios e não há tratamento definitivo ou efetivo. Existem várias medidas preventivas para reduzir complicações potenciais; alguns escolhem observação cuidadosa, outros a administração de outras drogas para tentar a diluição.
Subject(s)
Humans , Female , Pregnancy , Adult , Labor, Obstetric , Analgesia, Epidural , Medical Errors , Ampicillin/administration & dosage , Epidural SpaceABSTRACT
Abstract Background and objectives: Epidural action of neuromuscular blocking agents could be explained under the light of their physicochemical characteristics and epidural space properties. In the literature there are few cases of accidental neuromuscular agent's epidural administration, manifesting mainly with neuromuscular blockade institution or fasciculations. Case report: We report a case of accidental succinylcholine administration as an epidural test dose, in a female patient undergoing scheduled laparotomy, under combined general and epidural anesthesia. Approximately 2 min after the succinylcholine injection the patient complained for shortness of breath, while mild fasciculations appeared in her trunk and face, managed by immediate general anesthesia institution. With the exception of a relatively longer duration of neuromuscular blockade compared with intravenous administration, no neurological or cardiovascular sequelae or other symptoms of local or systemic toxicity were observed. Conclusions: Oral administration of diazepam seems to lessen the adverse effects from accidental epidural administration of succinylcholine. The meticulous and discriminative labeling of syringes, as well as keeping persistent cautions during all anesthesia procedures remains of crucial importance.
Resumo Justificativa e objetivos: A ação epidural de agentes bloqueadores neuromusculares pode ser explicada à luz de suas características físico-químicas e propriedades do espaço epidural. Na literatura existem poucos casos sobre a administração acidental em espaço epidural de agente neuromuscular que se manifesta principalmente com a instituição de bloqueio neuromuscular ou fasciculações. Relato de caso: Relatamos um caso de administração acidental de succinilcolina como uma dose teste epidural em uma paciente submetida à laparotomia programada, sob anestesia combinada geral e peridural. Aproximadamente dois minutos após a injeção de succinilcolina, a paciente queixou-se de falta de ar, enquanto fasciculações leves apareceram em seu tronco e rosto, tratadas com a instituição imediata de anestesia geral. Exceto pela duração relativamente longa do bloqueio neuromuscular em comparação com a administração intravenosa, sequelas neurológicas ou cardiovasculares ou outros sintomas de toxicidade local ou sistêmica não foram observados. Conclusões: A administração oral de diazepam parece diminuir os efeitos adversos da administração epidural acidental de succinilcolina. A meticulosidade e discriminação dos rótulos das seringas, bem como os cuidados persistentes mantidos durante todos os procedimentos de anestesia, continuam a ser de importância crucial.
Subject(s)
Humans , Female , Succinylcholine/administration & dosage , Medication Errors , Neuromuscular Depolarizing Agents/administration & dosage , Injections , Anesthesia, Epidural , Middle AgedABSTRACT
BACKGROUND: A lipo-prostaglandin E1 agonist is effective for the treatment of neurological symptoms of spinal stenosis when administered by an oral or intravenous route. we would like to reveal the therapeutic effect of an epidural injection of lipo-prostaglandin E1 on hyperalgesia in foraminal stenosis. METHODS: A total of 40 male Sprague-Dawley rats were included. A small stainless steel rod was inserted into the L5/L6 intervertebral foramen to produce intervertebral foraminal stenosis and chronic compression of the dorsal root ganglia (DRG). The rats were divided into three groups: epidural PGE1 (EP) (n = 15), saline (n = 15), and control (n = 10). In the EP group, 0.15 microg.kg-1 of a lipo-PGE1 agonist was injected daily via an epidural catheter for 10 days from postoperative day 3. In the saline group, saline was injected. Behavioral tests for mechanical hyperalgesia were performed for 3 weeks. Then, the target DRG was analyzed for the degree of chromatolysis, chronic inflammation, and fibrosis in light microscopic images. RESULTS: From the fifth day after lipo-PGE1 agonist injection, the EP group showed significant recovery from mechanical hyperalgesia, which was maintained for 3 weeks (P < 0.05). Microscopic analysis showed much less chromatolysis in the EP group than in the saline or control groups. CONCLUSIONS: An epidurally administered lipo-PGE1 agonist relieved neuropathic pain, such as mechanical hyperalgesia, in a rat foraminal stenosis model, with decreasing chromatolysis in target DRG. We suggest that epidurally administered lipo-PGE1 may be a useful therapeutic candidate for patients with spinal stenosis.
Subject(s)
Animals , Humans , Male , Rats , Alprostadil , Catheters , Constriction, Pathologic , Diagnosis-Related Groups , Fibrosis , Ganglia, Spinal , Hyperalgesia , Inflammation , Injections, Epidural , Neuralgia , Rats, Sprague-Dawley , Spinal Stenosis , Stainless SteelABSTRACT
To determine the differences in analgesic, hemodynamic and ventilatory effects between epidural and intravenous midazolam (MID), 44 adult patients, ASA grade Ⅰ to Ⅱ, scheduled for elective upper abdominal surgery. were randomly allocated to receiving epidural MID 0.05 mg/kg (group E_1) or 0.1 mg/kg (group E_2). or intravenous MID 0.05 mg/kg (group V_1) or 0.1 mg/kg (group V_2), respectively, The analegic effect was evaluated by pin-prink test, following MID administration. The hemodynamie and ventilatory values were measured by impedance cardiogra phy and side stream spirometry, before and 1.3, 5, 10, 15 and 20 mins after MID administration. Tbe results showed that the segmental spinal analgesia occured with MID in group E_1 and E_2, but no analgesia was produced with WID in group V_1 and V_2. Following MID administration in four groups, HR increased during first 5 mins (P0.05); CI, SI. LVWI, MAP, RPP and indices of myocardial eonstraction, cardiae peak flow and blood ejection velocity decreased slightly(P0.05). After MID administration, SpO_2 and VT were reduced (P0.05), and the inspiratory end-tidal oxygen content difference was elevated transiently (P0.05) and went down in group E_2 and V2(P0.05).