Inadvertent epidural injection of drugs for intravenous use. A review

Beckers, A., Verelst, P. and Van Zundert, A. (2012) Inadvertent epidural injection of drugs for intravenous use. A review. Acta Anaesthesiologica Belgica, 63 2: 75-79.

Author Beckers, A.
Verelst, P.
Van Zundert, A.
Title Inadvertent epidural injection of drugs for intravenous use. A review
Journal name Acta Anaesthesiologica Belgica   Check publisher's open access policy
ISSN 0001-5164
Publication date 2012
Year available 2012
Sub-type Critical review of research, literature review, critical commentary
Open Access Status
Volume 63
Issue 2
Start page 75
End page 79
Total pages 5
Place of publication Brussels, Belgium
Publisher Acta Medica Belgica
Language eng
Abstract Introduction : The frequency of inadvertent injection of drugs in the epidural space is probably underestimated and underreported, but it can cause serious morbidity and possibly mortality. Objective : The aim of this review is to collate reported incidents of this type, to describe the potential mechanisms of occurrence and to identify possible therapeutic solutions. Methods : We searched into medical databases and reviewed reference lists of papers retrieved. Results : A list is reported of more than 50 drugs that were inadvertently injected into the epidural space. This list includes drugs which produce no, little or short-lasting neurological deficits, but also includes drugs that may be more etching and can result in temporary or even permanent neurological deficit. Discussion : Most drugs do not lead to sequelae other than pain during injection or transient neurological complaints. Other drugs may have more deleterious consequences, such as paraplegia. Both the dose of the inadvertent injected drug and the time frame play an important role in the patient's outcome. "Syringe swap", "ampoule error", and epidural/intravenous line confusion due to inaccurate or absent colour coding of epidural catheters were the main sources of error. Preventive strategies, including non Luer-lock epidural injection ports, might increase safety.
Keyword Accidental
Adverse
Anesthesia
Epidural
Inadvertent
Prevention
Toxic reactions
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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Created: Thu, 07 May 2015, 12:32:02 EST by Andre Van Zundert on behalf of Anaesthesiology and Critical Care - RBWH