Related Experiment Video
Updated: Mar 11, 2026
Author Spotlight: Assessing Intrathecal Gene Therapy Efficacy in Juvenile Rats
Published on: March 29, 2024
Accidental Epidural Injection of Rocuronium in a Pediatric Patient: A Case Report and Literature Review
1Pharmacy Department, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
Insights
An accidental epidural injection of rocuronium in a pediatric patient resulted in temporary paralysis but no lasting harm. This case highlights the importance of vigilance in medication administration to prevent adverse events during surgery.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Accidental administration of non-epidural medications into the epidural or subarachnoid spaces can lead to severe patient harm.
- Safe medication practices are crucial in pediatric surgical procedures.
Observation:
- A 12-month-old patient undergoing hypospadias reconstruction received an unintended epidural injection of rocuronium (80 mg; 6.3 mg/kg) via the caudal route instead of ropivacaine.
- The patient experienced paralysis, indicated by 1/4 twitches on train-of-four monitoring, post-injection.
Findings:
- Despite the neuromuscular blockade, the patient remained hemodynamically stable and did not experience oxygen desaturation or hypoventilation.
- Neurological examination revealed no motor or sensory deficits, and the patient recovered without respiratory insufficiency.
- The child was discharged on postoperative day one with no sequelae noted at the one-week follow-up.
Implications:
- This case underscores the potential for unexpected outcomes with epidural medication errors.
- Prompt recognition and supportive care can mitigate the effects of accidental epidural rocuronium administration.
- Reinforces the need for meticulous drug verification processes in pediatric anesthesia.
Abstract:
Accidental administration of non-epidural drugs into the epidural or subarachnoid spaces may be associated with unexpected pain, morbidity, adverse effects, increased level of care, prolonged hospital stay, and mortality. We describe a 12-month-old admitted for secondary-stage hypospadias reconstruction. General anesthesia was induced with sevofiurane and a peripheral catheter was placed. Instead of ropivacaine, rocuronium (80 mg; 6.3 mg/kg) was injected into the epidural space by the caudal route. Surgery was uneventful and was completed 160 minutes after rocuronium was given. The patient exhibited paralysis with 1 of 4 twitches to the train-of-four with some posttetanic potentiation at the end of surgery. He was transferred to the pediatric intensive care unit for supportive ventilation and recovery. He did not experience oxygen desaturation or hypoventilation between the time of rocuronium administration and intubation. He was hemodynamically stable, without respiratory insufficiency, and his neurologic exam was normal, without motor or sensorial block. The patient was discharged home on the morning of the first postoperative day. Clinical examination 1 week after surgery revealed no lasting sequelae from the error.
Related Concept Videos
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:31Skeletal Muscle Relaxants: Therapeutic Uses
01:26Pharmaceutical Poisoning: Potential Scenarios