Anesthesia strategy for factor X deficiency coagulopathy: case report

Abstract Factor X deficiency ranks among the rarest coagulopathies and has a variable presentation spectrum. We intend to present a proposal for anesthesia protocol for individuals with the coagulopathy. The excision of an ovarian neoplasm was proposed for a 26-year-old, female, ASA II patient, with congenital Factor X deficiency. Physical examination and lab tests were normal, except for Prothrombin Time (PT) 22.1s (VR: 8-14s), International Normalized Ratio (INR) 1.99 (VR: 0.8-1.2) and Activated Partial Thromboplastin Time (aPTT) 41.4s (VR: 25-37s). We concluded that a history of bleeding should always be investigated, along with a pre-anesthetic coagulation study.

Inadvertent epidural ampicillin administration during labor: case report / Administração peridural inadvertida de ampicilina durante trabalho de parto: relato de caso

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.