Inadvertent intraarterial injection of propofol in a patient under general anesthesia

Abstract

injection of propofol under sedation or general anesthesia would be one of the important symptoms of intraarterial injection. In our case, the patient had an unpleasant sensation in the right metacarpophalangeal joints postoperatively. Propofol has been reported to produce vascular permeability change [3]. One case report mentioned that residual cutaneous hyperemia lasted for 12 days [4]. Furthermore, there is a possibility that intraarterial propofol attenuates capillary blood fl ow by particulate embolization or by physical interaction with blood components [5]. There may have been transient vascular hyperpermeability or a decrease in capillary blood fl ow in the present patient. Two laboratory studies [5,6] have shown that intraarterial propofol did not infl uence vasoactivity or vascular myogenic activity, and it was not toxic to the vessel wall. Intraarterial propofol has not been reported to cause irreversible sequelae, even when 8 ml of propofol was injected [1]. In contrast, the intraarterial injection of thiopental is known to cause endothelial cell destruction and necrosis, and urgent management of vasodilation or anticoagulation is required. Propofol may be a safer induction agent compared with thiopental. Nevertheless, it is important to prevent the intraarterial injection of propofol. After experiencing this incident, we have changed the color of the three-way stopcock to red, and the syringe has been connected to the three-way stopcock to avoid drug injection to the arterial route.