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Lokoff A, Maynes JT. The incidence, significance, and management of accidental intra-arterial injection: a narrative review. Can J Anaesth 2019; 66:576-592. [PMID: 30877587 DOI: 10.1007/s12630-019-01327-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022] Open
Abstract
This narrative review discusses the incidence, risk factors, mechanisms of injury, complications, and treatment regimens for accidental intra-arterial injection of medications. Despite awareness of the issue and the establishment of safety recommendations by national agencies, accidental iatrogenic intra-arterial injection of medications continues to occur. Most of these injuries are caused by accidental injection into an established arterial cannula or the inadvertent and unrecognized cannulation of an artery instead of a vein. Although many medications have been injected into arteries without significant consequence, a number of drugs are consistently associated with severe morbidity, including the need for amputation, making early incident recognition and treatment vital. Accidental intra-arterial injection of medications has also been increasingly reported in those who use illicit drugs, as these intravenous injection attempts can be misdirected into an artery. These reports have improved understanding of these injuries and possible treatment modalities. While the characteristics of injuries from illicit injections are diverse and the optimal treatment modalities are still uncertain, a regimen that includes anticoagulation and intra-arterial injection of thrombolytics and prostaglandins may improve outcomes. Steroids, vasodilators, and sympathetic blocks do not appear to influence amputation rates. Owing to the small and sporadic number of cases, no definitive clinical trial evidence exists, but the treatment modalities found to be useful in the illicit intra-arterial injection group may benefit treatment of similar iatrogenic injuries.
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Affiliation(s)
- Andrew Lokoff
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada. .,Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesia, University of Toronto, Toronto, ON, Canada
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Bulic K, Antabak A, Lorencin M. Near-Complete Hand Loss Following an Unintentional, Intra-arterial Medicine Injection in an Infant. J Pediatr Intensive Care 2018; 7:43-45. [PMID: 31073466 DOI: 10.1055/s-0037-1601336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 02/18/2017] [Indexed: 10/19/2022] Open
Abstract
Unintentional, intra-arterial administration of medicines can lead to very serious sequelae, including limb loss. We present a case of a 13-week-old boy who was unintentionally given phenobarbital into his right radial artery, which resulted in a near-complete hand amputation. Pediatric patients are under increased risk of such injuries due to their small vessel size and their inability to express immediate complaints, which often leads to a delayed recognition of the condition. As no specific treatment algorithms have been established, the mainstay of therapy is supportive care aimed at maintaining vascular patency. Prompt recognition is imperative in avoiding potentially detrimental effects; therefore, all personnel administering intravenous therapy should be aware of this possibility and be acquainted with the initial supportive measures.
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Affiliation(s)
- Kresimir Bulic
- Department of Surgery, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Anko Antabak
- Department of Surgery, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Mia Lorencin
- Department of Surgery, University of Zagreb School of Medicine, Zagreb, Croatia
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Salama T, Aghoutane EM, Fezzazi RE. [Gangrene of the hand due to accidental intra-arterial injection of floxacilline: about a case]. Pan Afr Med J 2017; 25:221. [PMID: 28293337 PMCID: PMC5337270 DOI: 10.11604/pamj.2016.25.221.10803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
La floxacilline appartient à la classe des pénicillines bêta lactames. Dans notre contexte elle est très utilisée pour lutter contre les infections à germes Gram positif dont le staphylocoque doré. Cependant son utilisation doit être très prudente car elle n’est pas dénuée de complications. Nous rapportons l’observation d’un garçon de 6 ans opéré pour fracture de l’humérus. L’enfant a été mis sous floxacilline injectable après suspicion d’une infection sur matériel 2 mois après son opération. Le lendemain du début de l’antibiothérapie, l’enfant a présenté une ischémie aigue de la main droite. Il nous a alors été adressé pour prise en charge. Les explorations ont objectivé une obstruction de l’artère radiale. Une aponévrotomie de décharge a été réalisée et une héparinothérapie post opératoire a été démarrée. L’évolution a été marquée par une gangrène de toute la main. A travers cette observation nous voulons sensibiliser le personnel soignant sur le risque de survenue de cette complication désastreuse, et les mesures à prendre pour la prévenir.
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Affiliation(s)
- Tarik Salama
- Service de Chirurgie Pédiatrique A, Départment des maladies de L'Enfant, CHU Mohammed VI, Université Cadi Ayyad, Marrakech, Maroc
| | - El Mohtadi Aghoutane
- Service de Chirurgie Pédiatrique A, Départment des maladies de L'Enfant, CHU Mohammed VI, Université Cadi Ayyad, Marrakech, Maroc
| | - Rédouane El Fezzazi
- Service de Chirurgie Pédiatrique A, Départment des maladies de L'Enfant, CHU Mohammed VI, Université Cadi Ayyad, Marrakech, Maroc
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Hancı V, Özbilgin Ş, Özbal S, Kamacı G, Ateş H, Boztaş N, Ergür BU, Arıkanoğlu A, Yılmaz O, Yurtlu BS. Evaluation of the effects of intra-arterial sugammadex and dexmedetomidine: an experimental study. Braz J Anesthesiol 2016; 66:456-64. [PMID: 27591458 DOI: 10.1016/j.bjane.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 01/30/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating the arterial endothelial effects of sugammadex and dexmedetomidine. The hypothesis of our study is that sugammadex and dexmedetomidine will cause histological changes in arterial endothelial structure when administered intra-arterially. METHODS Rabbits were randomly divided into 4 groups. Group Control (n=7); no intervention performed. Group Catheter (n=7); a cannula inserted in the central artery of the ear, no medication was administered. Group Sugammadex (n=7); rabbits were given 4mg/kg sugammadex into the central artery of the ear, and Group Dexmedetomidine (n=7); rabbits were given 1μg/kg dexmedetomidine into the central artery of the ear. After 72h, the ears were amputated and histologically investigated. RESULTS There was no significant difference found between the control and catheter groups in histological scores. The endothelial damage, elastic membrane and elastic fiber damage, smooth muscle hypertrophy and connective tissue increase scores in the dexmedetomidine and sugammadex groups were significantly higher than both the control and the catheter groups (p<0.05). There was no significant difference found between the dexmedetomidine and sugammadex groups in histological scores. CONCLUSION Administration of sugammadex and dexmedetomidine to rabbits by intra-arterial routes caused histological arterial damage. To understand the histological changes caused by sugammadex and dexmedetomidine more clearly, more experimental research is needed.
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Affiliation(s)
- Volkan Hancı
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey.
| | - Şule Özbilgin
- Dokuz Eylül University, School of Medicine, Department of Histology and Embryology, İnciraltı, İzmir, Turkey
| | - Seda Özbal
- Dokuz Eylül University, School of Medicine, Department of Histology and Embryology, İnciraltı, İzmir, Turkey
| | - Gonca Kamacı
- Dokuz Eylül University, School of Medicine, Department of Experienced Laboratory Animal Science, İnciraltı, İzmir, Turkey
| | - Hasan Ateş
- Dokuz Eylül University, School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, İnciraltı, İzmir, Turkey
| | - Nilay Boztaş
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey
| | - Bekir Uğur Ergür
- Dokuz Eylül University, School of Medicine, Department of Histology and Embryology, İnciraltı, İzmir, Turkey
| | - Ahmet Arıkanoğlu
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey
| | - Osman Yılmaz
- Dokuz Eylül University, School of Medicine, Department of Experienced Laboratory Animal Science, İnciraltı, İzmir, Turkey
| | - Bülent Serhan Yurtlu
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey
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Avaliação dos efeitos de sugamadex e dexmedetomidina intra‐arterial: estudo experimental. Braz J Anesthesiol 2016; 66:456-64. [DOI: 10.1016/j.bjan.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 01/30/2015] [Indexed: 11/23/2022] Open
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Hohenstein C, Herdtle S, Hoyme M, Lauten A, Chaudhary T. Rescue of the limb after accidental injection of diazepam into femoral artery. Am J Emerg Med 2014; 32:1149.e5-6. [DOI: 10.1016/j.ajem.2014.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022] Open
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