title: Inadvertent intrathecal injections and best practice management.
abstract: The intrathecal space has become an important anatomic site for medical intervention not only in anesthesia practice, but also in many other medical specialties. Undesired/inadvertent intrathecal injections (UII) are generally rare. There is tremendous variation in reported inadvertent administrations via an intrathecal route in the literature, mainly as individual cases and very small case-series reports. This review aims to identify potential sources of UII, its clinical presentations, and appropriate management. The inadvertent injectants are classified as anesthetic agents and pain medicines, chemotherapeutics, radiological contrast agents, antibiotics and corticosteroids, and miscellaneous chemical agents such as tranexamic acid. The clinical effects of UII are dependent upon inadvertent injectant(s) and dose being administered intrathecally, and can range from no adverse effect to profound neurological consequences and/or death. Prompt cerebrospinal fluid (CSF) lavage and cardiopulmonary support seem to be the mainstay of treatment. If serious consequences are anticipated, CSF lavage could be lifesaving. This review additionally provides some options for comprehensive management and preventing strategies.
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Tariq
authors.affiliation: Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Wuhan Central Hospital, Wuhan, Hubei, China.
authors.forename: H
authors.initials: H
authors.lastname: Yan
authors.affiliation: Department of Anesthesiology, LSUHSC-New Orleans, New Orleans, LA, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Kaye
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000767:Anesthesia, Epidural; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects*; D008508:Medication Errors; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D003287:Contrast Media; D009466:Neuromuscular Blocking Agents