Accidental intra-thecal tranexamic acid injection during spinal anesthesia for myomectomy: Case report and review

Suker, Khalid Abbas Owish; Elatta, Muna Omer Mohamed; Eljack, Mohammed Mahmmoud Fadelallah; Abdelmoneim, Abdelrahman H.; Fadl, Hiba Awadelkareem Osman; Mohamed, Ghazi Gasmalla

doi:10.1016/j.amsu.2022.104646

Cited by 2 publications

(9 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The fatality rate of 36% (8/22 patients) involved 6 of 13 women 12–15,17,21,23–26 and 2 of 8 male individuals. Full-term pregnant women had an increased risk of early mortality because of intrathecal TXA toxicity (2/5 women presented for LSCS) 15,17 .…”

Section: Resultsmentioning

confidence: 99%

“…The search flowchart (Supplementary File 1, http://links.lww.com/EJA/A805) shows 16 (of 18) reports of intrathecal TXA errors containing 22 (of 28) patients for inclusion in the analysis 11–26 Table 1. and Supplementary File 2, http://links.lww.com/EJA/A806 summarise personal details, the dose administered, clinical course, consequences and outcome.…”

Section: Resultsmentioning

confidence: 99%

“…The diagnosis of intrathecal TXA toxicity is clinical, and complications are mostly predictable (Table 1). In some instances, the diagnosis was delayed and confused with eclampsia, 33 local anaesthetic allergic reaction 23 or toxicity 26 . On occasions, the opportunity to prevent its recurrence was missed in the same hospital 12,14,17,18,22 …”

Section: Discussionmentioning

confidence: 99%

“…The individual organisation may face unique challenges and difficulties in promoting medication safety. For example, one author reported that TXA and local anaesthetic ampoules are imported into his country from another country (Dr Eljack, personal communication) 26 …”

Section: Discussionmentioning

confidence: 99%

“…For example, one author reported that TXA and local anaesthetic ampoules are imported into his country from another country (Dr Eljack, personal communication). 26 From the published reports, there is enough evidence that competing manufacturers and suppliers of TXA are not aware that TXA product design and labelling, in many instances, are identical to local anaesthetic ampules or vials (Fig. 1).…”

Section: Diagnosismentioning

confidence: 99%

See 4 more Smart Citations

Tranexamic acid-associated intrathecal toxicity during spinal anaesthesia

Patel

2023

European Journal of Anaesthesiology

View full text Add to dashboard Cite

Therapeutic use of tranexamic acid (TXA) to minimise blood loss is common during a wide range of surgical procedures. This review aims to explore the clinical features of the accidental intrathecal administration of TXA and to identify contributory factors that might prevent future incidents. The author searched published reports of accidental intrathecal administration of TXA using Medline and Google Scholar databases from July 2018 to September 2022, including error reports in any language but excluding errors via nonintrathecal routes. The human factors analysis classification system (HFACS) framework was used to examine and classify the human and systemic factors that contributed to the errors. Twenty-two errors of accidental intrathecal administration were reported during the search period. The analysis showed that the outcome was death in eight patients (36%) and permanent harm in four (19%). The fatality rate was higher among female individuals (6/13 versus 2/8 male individuals). Two-thirds of errors (15/22) occurred during orthopaedic surgery (10) and lower segment caesarean sections (5). Nineteen of 21 patients developed refractory or super refractory status epilepticus, requiring mechanical ventilation and intensive care for 3 days to 3 weeks for those who survived the initial few hours. Severe sympathetic stimulation resulting in refractory ventricular arrhythmias was the final event in some patients, with death within a few hours. Lack of familiarity with clinical characteristics caused delayed diagnosis or confusion with other clinical conditions. A proposed plan to manage intrathecal TXA toxicity is presented, including immediate cerebrospinal fluid lavage; however, there is no specific approach. The HFACS suggested mistaking look-alike TXA ampoules for local anaesthetic was the predominant cause. The author concludes that inadvertent intrathecal TXA is associated with mortality or permanent harm in more than 50% of patients. The HFACS demonstrates that all errors are preventable.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%