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 1g 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.
Subject(s)
Ampicillin/administration & dosage , Analgesia, Epidural , Labor, Obstetric , Medical Errors , Adult , Epidural Space , Female , Humans , PregnancyABSTRACT
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
BACKGROUND AND OBJECTIVES: One-lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position. CASE REPORT: We present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound. CONCLUSION: US is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion.
Subject(s)
Auscultation , Intubation, Intratracheal/methods , Lung/diagnostic imaging , One-Lung Ventilation/methods , Ultrasonography , Humans , Infant, Newborn , Male , StethoscopesABSTRACT
Abstract Background and objectives: One-lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position. Case report: We present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound. Conclusion: US is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion.
Resumo Justificativa e objetivos: A ventilação monopulmonar e a intubação seletiva em recém-nascidos podem ser um desafio devido às especificidades fisiológicas intrínsecas e ao material disponível. O aparelho de ultrassom tem sido cada vez mais usado em muitas situações no campo da anestesia, incluindo a confirmação da posição do tubo endotraqueal. Relato de caso: Apresentamos o relato do caso de um recém-nascido proposto para lobectomia pulmonar por toracoscopia em que a exclusão pulmonar foi confirmada por ultrassom. Conclusão: O ultrassom é um método rápido, mais sensível e específico do que a ausculta para avaliar a intubação traqueal e a exclusão pulmonar.