Beckers A, Verelst P, van Zundert A
Catharina Hospital - Department of Anesthesiology, Eindhoven, The Netherlands.
Acta Anaesthesiol Belg. 2012;63(2):75-9.
The frequency of inadvertent injection of drugs in the epidural space is probably underestimated and underreported, but it can cause serious morbidity and possibly mortality.
The aim of this review is to collate reported incidents of this type, to describe the potential mechanisms of occurrence and to identify possible therapeutic solutions.
We searched into medical databases and reviewed reference lists of papers retrieved.
A list is reported of more than 50 drugs that were inadvertently injected into the epidural space. This list includes drugs which produce no, little or short-lasting neurological deficits, but also includes drugs that may be more etching and can result in temporary or even permanent neurological deficit.
Most drugs do not lead to sequelae other than pain during injection or transient neurological complaints. Other drugs may have more deleterious consequences, such as paraplegia. Both the dose of the inadvertent injected drug and the time frame play an important role in the patient's outcome. "Syringe swap", "ampoule error", and epidural/intravenous line confusion due to inaccurate or absent colour coding of epidural catheters were the main sources of error. Preventive strategies, including non Luer-lock epidural injection ports, might increase safety.
硬膜外腔误注药物的发生率可能被低估且报告不足，但这可能导致严重的发病甚至死亡。
本综述的目的是整理此类报告事件，描述其潜在发生机制并确定可能的治疗方案。
我们检索了医学数据库并查阅了所检索论文的参考文献列表。
报告了一份超过50种被误注入硬膜外腔的药物清单。该清单包括那些不会、很少或仅产生短暂神经功能缺损的药物，但也包括可能更具侵蚀性并可导致暂时甚至永久性神经功能缺损的药物。
大多数药物除了注射时疼痛或短暂的神经症状外不会导致后遗症。其他药物可能有更有害的后果，如截瘫。误注药物的剂量和时间范围对患者的预后都起着重要作用。“注射器交换”、“安瓿错误”以及由于硬膜外导管颜色编码不准确或缺失导致的硬膜外/静脉线路混淆是主要的错误来源。包括非鲁尔锁硬膜外注射端口在内的预防策略可能会提高安全性。
