Inadvertent intrathecal injection of tranexamic acid

Abstract

Some factors have been identified as contributing to medical errors such as labels, appearance, and location of ampules. In this case report, inadvertent intrathecal injection of 80 mg tranexamic acid was followed by severe pain in the back and the gluteal region, myoclonus on lower extremities and agitation. General anesthesia was induced to complete surgery. At the end of anesthesia, patient developed polymyoclonus and seizures needing supportive care of the hemodynamic, and respiratory systems. He developed ventricular tachycardia treated with Cordarone infusion. The patient’s condition progressively improved to full recovery 2 days after. Confusion between hyperbaric bupivacaine and tranexamic acid was due to similarities in appearance between both ampules.

Tranexamic acid–associated seizures: Causes and treatment

“…Consistent with this notion that anesthetics protect against TXA‐induced seizures, many patients first develop seizures during emergence from propofol sedation 17, 24. Also, case reports indicate that propofol is effective for treating seizures in patients who inadvertently received an intrathecal injection of TXA 15, 23. Although treatment with a general anesthetic is likely to be effective, these drugs should only be administered under conditions that allow their safe use.…”

“…Reports of patients who received an accidental intrathecal injection of TXA have offered rare insights into the clinical manifestation of TXA‐associated seizures 11, 13, 15, 19, 23, 29. These patients experienced severe back pain that radiated below the waist, with burning pain in the lower limbs and gluteal region 11, 13, 15, 19, 23, 29. Involuntary motor activity, such as a “jerking” of the lower extremities (referred to as myoclonic movements) and twitching of facial muscles, was also observed 11, 12, 13, 15, 19, 23.…”

“…These patients experienced severe back pain that radiated below the waist, with burning pain in the lower limbs and gluteal region 11, 13, 15, 19, 23, 29. Involuntary motor activity, such as a “jerking” of the lower extremities (referred to as myoclonic movements) and twitching of facial muscles, was also observed 11, 12, 13, 15, 19, 23. These abnormal movements rapidly progressed to generalized tonic–clonic seizures 11, 12, 13, 15, 19, 23.…”

“…Involuntary motor activity, such as a “jerking” of the lower extremities (referred to as myoclonic movements) and twitching of facial muscles, was also observed 11, 12, 13, 15, 19, 23. These abnormal movements rapidly progressed to generalized tonic–clonic seizures 11, 12, 13, 15, 19, 23. Myoclonic movements may serve as a warning sign of impending seizures.…”

“…However, observational clinical trials and case reports have shown that TXA, and to a lesser extent EACA, but not aprotinin, are associated with seizures 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34. Most TXA‐associated seizures occur in patients who have undergone cardiac procedures 16, 17, 18, 20, 21, 24, 25, 26, 30, 31, 32, 34.…”