背景:氨甲环酸是一种众所周知的抗纤维蛋白溶解药物,常用于出血性疾病患者。意外鞘内注射氨甲环酸后,主要的发病率和死亡已经记录在案。本病例报告的目的是提出一种鞘内注射氨甲环酸的新方法。
方法:在本案例报告中,鞘内注射400毫克氨甲环酸导致严重的背部和臀部疼痛,下肢肌阵鸣,激动,一名有左臂和右腿骨折病史的31岁埃及男性广泛惊厥。立即使用咪达唑仑(5mg)和芬太尼(50μg)进行静脉内镇静,癫痫发作终止时无反应。静脉输注1000毫克苯妥英,随后,全身麻醉诱导采用硫喷妥钠(250mg)和阿曲库铵(50mg)输注,病人的气管插管。通过异氟烷1.2最低肺泡浓度和阿曲库铵10mg每20分钟实现麻醉维持。和随后的剂量硫喷妥钠(100毫克),以控制癫痫发作。病人在手和腿部出现局灶性癫痫发作,所以脑脊液灌洗是通过插入两根脊髓22号Quincke针来完成的,一个在L2-L3级(排水)上,另一个在L4-L5上。通过被动流动在1小时内进行鞘内生理盐水输注(150ml)。脑脊液灌洗和患者的稳定后,他被转移到重症监护室。
结论:早期和连续鞘内灌洗生理盐水,与气道,呼吸,和循环方案强烈建议降低发病率和死亡率。在重症监护病房中选择吸入药物作为镇静剂和用于脑保护,为处理此事件和用药错误提供了可能的益处。
BACKGROUND: Tranexamic acid is a well-known antifibrinolytic medication frequently prescribed to individuals with bleeding disorders. Following accidental intrathecal injection of tranexamic acid, major morbidities and fatalities have been documented. The aim of this
case report is to present a novel method for management of intrathecal injection of tranexamic acid.
METHODS: In this
case report, a 400 mg intrathecal injection of tranexamic acid resulted in significant back and gluteal pain, myoclonus of the lower limbs, agitation, and widespread convulsions in a 31-year-old Egyptian male with history of left arm and right leg fracture. Immediate intravenous sedation with midazolam (5 mg) and fentanyl (50 μg) was delivered with no response in seizure termination. A 1000 mg phenytoin intravenous infusion and subsequently, induction of general anesthesia was performed by
thiopental sodium (250 mg) and atracurium (50 mg) infusion, and the trachea of the patient was intubated. Maintenance of anesthesia was achieved by isoflurane 1.2 minimum alveolar concentration and atracurium 10 mg every 20 minutes, and subsequent doses of
thiopental sodium (100 mg) to control seizures. The patient developed focal seizures in the hand and leg, so cerebrospinal fluid lavage was done by inserting two spinal 22-gauge Quincke tip needles, one on level L2-L3 (drainage) and the other on L4-L5. Intrathecal normal saline infusion (150 ml) was done over an hour by passive flow. After cerebrospinal fluid lavage and the patient\'s stabilization was obtained, he was transferred to the intensive care unit.
CONCLUSIONS: Early and continuous intrathecal lavage with normal saline, with the airway, breathing, and circulation protocol is highly recommended to decrease morbidity and mortality. The selection of the inhalational drug as a sedative and for brain protection in the intensive care unit provided possible benefits in management of this event with medication errors.