Accidental Injection Research Articles

Intraarterial Injection of Drugs of Abuse into Femoral Artery: Case Report and Review of the Literature

Accidental intraarterial injection is a serious condition which can compromise the viability of the limb within hours. There are no evidence based guidelines suggesting the proper treatment protocol and there is no consensus about the ideal treatment for these events. We present a case where a mixture of benzodiazepine pills and street heroin was injected in right femoral artery. Patient arrived in hospital days after event. With intraarterial application of thrombolysis, vasodilators and heparin major amputation was avoided. It seems that in selected cases combined therapy with rtPA lysis and PGE1 intra-arterial infusion may prevent major limb amputation even in delayed presentation of acute leg ischaemia caused by inadvertent injection of drugs of abuse.

Ultrasound-Guided Stellate Ganglion Block to Treat Accidental Injection of Propofol in an Anomalous Radial Artery

Intra-arterial drug administration is a rare but potentially dreadful condition which can result in ischemia and gangrene of the hand. In the present case we accidentally injected propofol in an anomalous radial artery during anesthesia induction. Serial ultrasound-guided stellate ganglion blocks were applied to salvage the limb of the patient by promoting arterial blood flow. This is probably the first reported case of accidental intra-arterial injection of propofol being managed with stellate ganglion block.

THE DAMAGE OF THE OPTIC NERVE AS THE OUTCOME OF UNINTENTIONAL POISONING BY CLOSANTEL

Background: In recent decades, the problem of toxic damage of the visual system due to poisoning by various medicines has become particularly relevant. The clinical case of a bilateral acute optic neuropathy of toxic genesis in a patient by the unintentional application of closantel used in veterinary practice is presented in the report. Closantel is a structural derivative of the salicylanilides, which is used exclusively in veterinary medicine for the prevention and treatment of large and small-scale cattle. Neurological and ophthalmic symptoms are often associated with the intoxication of closantel. Objective: To describe the toxic damage of the optic nerve due to unintentional poisoning by closantel. Methods: A patient aged 55 years is examined. A standard survey of ophthalmology was carried out. Photoregistration of the ocular fundus was used by a funduscamera Visucam 500 (Carl Zeiss Meditec AG, Germany), from special methods of research - the spectral optical coherence tomography (OCT) with a study of the macular area of the retina and the disc of the optic nerve on the device Zeiss Cirrus 5000 (Carl Zeiss Meditec, USA) and the optical coherence tomography with the function of angiography (OCT-A) of the macular area of the retina using RTVue XR Avanti (Optovue, USA) Results: The patient complained of a severe, yet painless, reduction in vision of both eyes after an accidental intramuscular injection of the medicine called "Closantrem" in dose 4.0 ml. The visual acuity OU - an accounting of fingers on the face at a distance of 10 cm. By ophthalmoscopy OU: the disc of the optic nerve is discolourated, its boundaries are indistinct, the arteries and the veins are narrowed, in the macular area of the retina without a visible physical pathology. The perimetry is in the correct projection of the light. A reduction in the thickness of the external and internal layers of the retina was observed as a result of the OCT of the macular zone OU. According to OCT of the disc of the optic nerve: the thickness of the layer of nerve fibres is in the upper and lower nasal segments. OS – the prominence of the disc of the optic nerve in vitreous. The fascinated changes of the cerebral cortex have not been found during the MRT. The diagnosis was made OU: Acute optic neuropathy of toxic genesis. A course of integrated conservative treatment has been introduced: the anti-inflammatory, metabolic, nootropic, vitamin therapy, magnetotherapy, electrostimulation and electrophoresis. Conclusion: Potentially, any medicines are toxic, which may cause a number of side effects from the visual and central nervous system. The toxic damage of the ganglion cells of the retina was initially occurring due to unintentional application of closantel, resulting in a reduction of the central visual acuity, followed by the development of the optic nerve atrophy.

Accidental injection of EDTA instead of anesthesia solution during root canal treatment: Case report

Background/Aim: Many irrigation solutions are used during root canal treatment. It is unacceptable to confuse irrigation solutions with anesthetic solution and inadvertently inject the patient. After such an error, local and systemic serious complications can be seen in the patient. The purpose of this case report is to show how careless use of etilendiamin tetraacedic acid (EDTA) can result in important complications, and offer some treatment methods for curing symptoms resulting from such complications. Case Report: A 17% EDTA solution, was inadvertently injected in the buccal mucosa of a 20-year-old male during routine root canal treatment. Severe pain, bleeding and mucosal swelling occurred shortly after the injection. Irrigation with saline was performed by sliding the mucoperiosteal flap at the injection site. Then the flap was sutured primary. At the control one week later, there were no areas of necrosis in the patient, but ecchymosis occurred. Decalcified areas were not detected in dental volumetric tomography examination. Conclusions: The dentists must apply the precautions of EDTA irrigation solution during the root canal treatment and manage the treatment of this clinical complication.

Management of Accidentally Injected Ivermectin Overdose Inflicted Toxicity in German Shepherd Dog

An owner complaint about adverse reaction half an hour after accidental injection of ivermectin to a dog. The dog showed hyperthermia, bradycardia, dyspnoea, hypersalivation and frothy discharge, dilated pupil and ataxia. The dog was symptomatically treated with normal saline, dexamethasone, tribivet-M and atropine sulphate. Adverse symptoms were abolished after two hours. Instant reporting by the owner and prompt treatment in the present study helps to avoid further deterioration in the dog's condition and made possible fast recovery.

Pharmacokinetics and Safety of INL-001 (Bupivacaine HCl) Implants Compared with Bupivacaine HCl Infiltration After Open Unilateral Inguinal Hernioplasty.

IntroductionSurgical site infiltration with bupivacaine HCl results in short-lived analgesia for postsurgical pain and carries the risk of systemic bupivacaine toxicity due to accidental intravascular injection. INL-001 is a bupivacaine HCl collagen-matrix implant that provides extended delivery of bupivacaine directly at the site and avoids the risk of accidental injection. Here, we examine the pharmacokinetic (PK) and safety profile of INL-001 placement during unilateral open inguinal hernioplasty.MethodsThis multicenter, single-blind study (NCT03234374) enrolled patients undergoing open inguinal hernioplasty to receive three INL-001 implants, each containing 100 mg bupivacaine HCl (n = 34) or local infiltration of 0.25% bupivacaine HCl 175 mg (n = 16). Acetaminophen was provided in the postsurgical period and supplemented by opioids for breakthrough pain, as needed. PK blood samples were taken before surgery and up to 96 h after drug administration.ResultsINL-001 demonstrated a prolonged rate of absorption and clearance of bupivacaine compared with 0.25% bupivacaine HCl 175 mg, as demonstrated by a longer time to peak plasma concentration and terminal elimination half-life. Peak plasma concentration with INL-001 300 mg was comparable to bupivacaine HCl 175 mg and well below levels associated with systemic bupivacaine toxicity. The most common adverse events (AEs) in both groups were associated with general anesthesia and the postsurgical setting. No AE was related to the implant, including those associated with wound healing.ConclusionsThese findings demonstrate that INL-001 provides immediate and extended delivery of bupivacaine and is well tolerated in patients undergoing open inguinal hernioplasty with no adverse effect on wound healing.Trial registrationClinicaltrials.gov identifier, NCT03234374.Electronic supplementary materialThe online version of this article (10.1007/s12325-020-01565-x) contains supplementary material, which is available to authorized users.

Токсическое поражение зрительной системы при непреднамеренном отравлении салициланилидом

The patient complained of a severe, yet painless, reduction in vision of both eyes after an accidental intramuscular injection of Klozantrem with a dose of 4.0 ml in S. Fedorov Eye Microsurgery Federal State Institution. The standard ophthalmological examination was performed (OU visual acuity was counting fingers at a distance of 10 cm, OD intraocular pressure was 10mm Hg, OS intraocular pressure was 9 mm Hg, eye movement unremarkable). Biomicroscopy showed both eyes were calm, pale pink conjunctivae, transparent cornea, medium depth anterior chamber, transparent lens. OU ophthalmoscopy showed the optic disc was discolourated, its boundaries were indistinct, arteries and veins were narrowed, macular area of the retina without a visible physical pathology. Perimetry showed the correct light projection. A reduction in the thickness of the external and internal layers of the retina was observed as a result of the OCT of the macular zone OU. OCT showed the thickness of the layer of nerve fibres in the upper and lower nasal segments. OS has the prominence of the optic disc in the vitreous body. The threshold of the electrical sensitivity OU was 300 mkA by electrophysiological research; the electrical latency was not defined. During the MRI scan, the fascinated changes of the cerebral cortex have not been found. Acute optic neuropathy of toxic genesis was diagnosed in both eyes. A course of complex conservative treatment was prescribed: anti-inflammatory, nootropic, metabolic, vitamin therapy, as well as magnetotherapy, electrical stimulation and electrophoresis. As a result of the reported case by patient due to unintentional application of Closantel, we found that toxic damage of the ganglion cells of the retina was initially occurring, resulting in a reduction of the central visual acuity, followed by the development of the optic nerve atrophy. Care must be exercised when dealing with medicines. Potentially, any medicines are toxic and, if used improperly, may cause a number of side effects from the visual and central nervous system.

Pathogenic Mechanisms of a Stroke-like attack Elicited by Epidural Steroid Injection Therapy.

The pathogenic mechanisms involved in a disastrous scenario, following epidural steroid injections (ESI), remain unclarified. Intra-arterial injection of steroids with needlepenetrating vascular injury would be the culprit, as particulate medicine elicits a brain or spinal cord stroke-like attack. On the other hand, the limited experimental approaches simulating an accidental steroid intra-arterial injection for ESI conflicted in their results: hemorrhage vs. ischemia. This article dissects the potential pathogenic mechanisms at a neurovascular unit. Noticeably, a schematic representation provides an explanation of how emboli formed by particulate steroids elicit either hemorrhagic, or ischemic lesion. In addition, the development of a rat model with intravertebral artery steroid injection is a proposal to address the unmet need in evaluating steroids and vascular injury in ESI.

User experience for manual injection of 2 mL viscous solutions is enhanced by a new prefillable syringe with a staked 8 mm ultra-thin wall needle

ABSTRACT Objectives User experience was compared between a new pre-fillable 2.25 mL glass syringe equipped with an ultra-thin-wall (UTW) 8 mm staked needle and a marketed BD Neopak™ syringe equipped with a special-thin-wall (STW) 12.7 mm staked needle. Methods Participants simulated subcutaneous injections with both syringes alone (formative Human Factors study) and in combination with a needlestick-prevention device (validation Human Factors study). Results Usability results of both studies showed higher success rates for delivering the full dose of 2 mL viscous solution (30 cP) with the 8mmUTW syringe than with the 12.7mmSTW one (63% vs. 42% in the formative study). The use of the 8mmUTW syringe demonstrated also better ease of use and acceptance results and 72% of formative study participants preferred this new syringe over the current one when delivering the viscous solution. Using a shorter needle also showed a benefit in decreasing the injection-related anxiety. Besides, in the case of a non-recommended injection technique, the calculated risk of accidental intramuscular injection is reduced by 2 to 13 times with the 8mmUTW syringe. Conclusion Altogether, the results obtained demonstrated an improvement of the user experience with this new syringe compared to the current one in the manual delivery of 2 mL viscous solutions.

ISMP updates: Remdesivir, propofol, and vincristine

ISMP updates: Remdesivir, propofol, and vincristine

Gangrene of the Fingers after Accidental Intra-Arterial Injection of Diazepam in Mali: Case Report and Review of the Literature

Gangrene of the Fingers after Accidental Intra-Arterial Injection of Diazepam in Mali: Case Report and Review of the Literature

Accidental Injection of Propofol into a Lumbar Drain.

Accidental Injection of Propofol into a Lumbar Drain.

Upper Limb Arterial Ischemia Occurred After Accidental Antibiotics Intra-Arterial Injection: Report of Three Cases

Upper Limb Arterial Ischemia Occurred After Accidental Antibiotics Intra-Arterial Injection: Report of Three Cases

Acute Upper Limb Ischemia after an Accidental Intra-Arterial Antispasmodic Injection on an Anatomical Variant of the Radial Artery: A Case Report and Review of the Literature

Acute Upper Limb Ischemia after an Accidental Intra-Arterial Antispasmodic Injection on an Anatomical Variant of the Radial Artery: A Case Report and Review of the Literature

Stocktaking of local anesthetics 2020

For decades local anesthetics have proven to be safe and effective drugs in the clinical practice, crucially promoting the enormous achievements in regional anesthesia. Meanwhile, it is awell-known fact that local anesthetics are much more than just "simple" sodium channel blockers. They also interact with numerous other ion channels and subcellular structures, enhancing nerve blockade and resulting in systemic "alternative" effects, which can sometimes even be clinically used. By the simultaneous administration of various adjuvants (e.g., opioids, corticosteroids and α2-receptor agonists) attempts are made to prolong the time of action of local anesthetics after a single administration in order to achieve the best possible improvement in postoperative analgesia. In this context, ultralong-acting local anesthetics, such as liposomal bupivacaine, which at least theoretically can provide a sensory nerve block for several days, have been developed and clinically introduced. The coming years will show whether these approaches will develop into genuine alternatives to the personnel and cost-intensive continuous nerve blockades.Local anesthetic-induced systemic toxicity is meanwhile rare but still a potentially life-threatening event, frequently resulting from accidental intravascular injection or extensive systemic resorption. Consequently, slow and fractional application of these agents with intermittent aspiration helps to prevent toxic sequelae. If toxic symptoms occur, however, the intravenous infusion of 20% lipid solutions in addition to basic treatment measures can enhance the success of treatment.

Continuous stellate ganglion block for the effective management of ischemic pain following compartment syndrome of upper limb due to accidental intra-arterial injection

In the present era of advanced medicine and patient safe practice, accidental intra-arterial injection of drugs is a rare occurrence. Compartment syndrome (CS) is one of its most detrimental complications, which leads to loss of circulation, ischemia, myonecrosis, nerve damage, and limb loss. Rapid recognition and emergent fasciotomy to relieve the compartment pressure are imperative to prevent irreversible damage. Sympathetic blockade is one of the most common interventions used in the management of early stages of CS, which interferes with the pain cycle and improves distal flow by vasodilatation. We report a complicated case of CS of the right upper limb following accidental intra-arterial injection. The patient suffered with persistent ischemic pain despite surgical decompression, which was successfully managed by continuous stellate ganglion block.

Evaluation & Management of Accidental Intra-Arterial Injection in the Ante-Cubital Fossa

Introduction: Intra-arterial drug injection is a rare, but a potentially serious medical emergency. It is most commonly seen as an iatrogenic complication when administering an intravenous medication. Accidental Intra-arterial injection was defined as an intravenous injection administered in the upper limb for any illness, which was followed by sudden severe pain in the limb followed by bluish discoloration of any part of the affected limb. Aim: The aim of the study is to identify the risk factors early on for limb amputation following intra-arterial injection. Also, to assess the efficacy of the various modalities of the treatments administered, and establish a standardized treatment plan for intra-arterial injection to achieve limb salvaging. Materials and methods: A total of twelve cases of accidental intra-arterial injection were studied for the efficacy of early evaluation and management of each. The patients were studied based on Rutherford Classification, clinical history, and Doppler findings. Results: Ten out of the twelve patients presented early and limb salvation was achieved. Conservative treatment and upper limb Fasciotomy proved to aid with the limb salvation. However, two out of the twelve patients presented after 12 hours with complains of blackening of the digits. In these patients, limb salvation was not achieved and Ray’s amputation was performed. All the patients recovered well, with proper functioning of the upper limb. Conclusion: Early evaluation and management of a case of accidental intra-arterial injection is of utmost importance due to its serious complications. Lastly, all medical professionals must be regularly trained in order to prevent such mishaps from happening.

Repositioning of inadvertent intralenticular ozurdex

With increasing availability and acceptability of intravitreal injections for various pathologies, the number of patients undergoing intravitreal injections has grown exponentially, hence increasing the risk of accidental trauma to the crystalline lens. One of the gravest and rarest complications is the inadvertent intralenticular implantation of ozurdex implant, causing immediate cataract formation. As available resources in the developing countries are limited, aim of the cataract surgery should be to reposition the same implant in the vitreous cavity, through the preexisting posterior capsular dehiscence, and placing an intraocular lens to prevent anterior migration of the implant. Due to the presence of posterior capsular dehiscence, some amount of lens matter may drop into the vitreous and can invoke postoperative uveitis and raised intraocular pressures. We report such a rare case of accidental intralenticular injection of ozurdex implant, our unconventional surgical approach and the long-term follow-up.

Three-Dimensional Imaging Angiography (3DIA) vs Fluoroscopy To Reveal Intravascular Injection During Lumbar Transforaminal Steroid Injection: A Retrospective Study

Demonstrate of accidental intravascular injection during lumbar transforaminal anterior epidural steroid injection (TAESI) performed with three-dimensional imaging angiography (3DIA) and fluoroscopy.We assessed 20 (9 males and 11 females) patients (with a total of 40 levels) whose images were received with simultaneously 3DIA and fluoroscopy-guided TAESI between January 2016 and September 2016 as retrospective. Injections were carried out in the lumbar fourth intervertebral space bilaterally and performed in the same way all of the cases.The mean age and body mass index of the patients were 47.9±2.72 years and 26.95±1.21, respectively. There were 10 patients with disc herniation, seven patients with spinal stenosis, and three patients with failed back surgery syndrome. In 3D imaging, vascular escape was detected in the 7 levels (17.5%) which were thought to be no escape in the fluoroscopy imaging.In chronic lumbar radiculopathy patients, intravascular escapes may occur during the fluoroscopic TAESI procedure. To avoid intravascular injections during TAESI procedure, it may be appropriate to use different imaging methods that can give more detailed results such as 3D angiography.

Ultrasound-guided T2 and T3 paravertebral block versus ultrasound-guided stellate ganglion block in acute upper limb ischemia

Background Accidental intra-arterial injection can cause severe limb ischemia, often resulting in amputation. We reported a number of cases of acute upper limb ischemia with severe pain and ischemia in vascular surgery department for urgent relief of the pain and ischemia. Either ultrasound-guided stellate ganglion block or thoracic paravertebral block was done to protect upper limb from gangrene and amputation. Purpose The aim of the present study is to compare the effect of ultrasound-guided stellate ganglion block with ultrasound-guided thoracic T2 and T3 paravertebral block in relief of pain and ischemia and also to compare the result of the block and complications. Patients and methods Forty American Society of Anaesthesiologists status I–II adult patients 16–60 years of age with acute upper limb ischemia and severe pain were admitted to Vascular Surgery Department of Zagazig University Hospital. They were randomly divided into two groups: group S (n=20) where ultrasound-guided stellate ganglion block was done, and group TPV (n=20), where ultrasound-guided thoracic paravertebral block was done. Both groups received 10 ml bupivacaine (0.25%)+16 mg dexamethasone for relief of the pain and ischemia, and the complications that resulted from the procedure were followed and recorded. Results There was significant decrease in visual analog scale in both groups after the stellate ganglion block and thoracic paravertebral block, with minimal complications with thoracic paravertebral block and relief of pain and ischemia in both groups. Conclusion Thoracic paravertebral block is a good choice in acute upper limb ischemia with rapid relief of the pain and restoration of peripheral perfusion with minimal complications.