title: Intravenous propofol precipitates the hypotension induced by inadvertent epidural thiopental injection.
abstract: Administration of improper drugs into epidural space is occasionally present in anesthetic practice. In most instances it would not contribute to significant neurological complications. There had not been severe hypotension reported in the literature in consequence of inadvertent epidural thiopental administration. Here we describe our experience in a case of inadvertent epidural administration of thiopental coinciding with induction of anesthesia with propofol, as a consequence of which profound hypotension was induced, necessitating aggressive inotropic and vasopressive agents to maintain blood pressure. Rapid vascular uptake of thiopental in the epidural space and synergistic action of propofol jointly contributed to the development of the hypotension. Attempts to forestall neurological sequela after the inadvertence seem unnecessary unless apparent symptoms or signs of neurological injury have come upon.
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Shui-Yuan
authors.initials: SY
authors.lastname: Huang
authors.forename: Chao-Chun
authors.initials: CC
authors.lastname: Wang
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Chang
authors.forename: Kwok-Hon
authors.initials: KH
authors.lastname: Chan
authors.forename: Chi-Chun
authors.initials: CC
authors.lastname: Chu
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D004357:Drug Synergism; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D007268:Injections, Epidural / Q000009:adverse effects*; D008297:Male; D008508:Medication Errors; D015742:Propofol / Q000494:pharmacology*; D013874:Thiopental / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D018686:Anesthetics, Intravenous; D013874:Thiopental; D015742:Propofol