Neves Sara S, Almeida Joana
Department of Anesthesiology, Centro Hospitalar Universitário de Santo António, Porto, PRT.
Cureus. 2024 Jul 25;16(7):e65371. doi: 10.7759/cureus.65371. eCollection 2024 Jul.
Inadvertent injection of drugs into the epidural space has a potential for serious morbidity and is probably underestimated and underreported. A 39-year-old female with no medical history presented for delivery. An epidural catheter was requested and correctly placed. Continuous epidural infusion was chosen for labor analgesia. Six hours after the parturient complained about inefficient analgesia, a syringe swap with insulin was identified. Despite the risk of possibly neurotoxic preservatives in the insulin formulation, no neurological sequelae were observed. This case highlights the issue of wrong-route drug administration and the urgent need to adopt route-specific connections.
意外将药物注入硬膜外腔有导致严重发病的可能性，且可能被低估和漏报。一名无病史的39岁女性前来分娩。应要求置入了硬膜外导管且放置正确。选择持续硬膜外输注用于分娩镇痛。产妇抱怨镇痛效果不佳6小时后，发现与胰岛素的注射器发生了交换。尽管胰岛素制剂中可能存在具有神经毒性的防腐剂，但未观察到神经后遗症。该病例凸显了错误给药途径的问题以及采用特定途径连接的迫切需求。
