Inadvertent Intra-Arterial Methohexital Injection During Procedural Sedation: A Case Report and Contemporary...

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Barbiturates are historically significant in anesthesia and sedation.
• Accidental intra-arterial injections of barbiturates can lead to severe complications like thrombosis, tissue necrosis, and gangrene.
• Current literature lacks contemporary management recommendations for these events.

Purpose of the Study:

• To propose a management protocol for accidental intra-arterial barbiturate administration.
• To mitigate thrombotic complications and prevent tissue damage following such incidents.

Main Methods:

• A recent case of intra-arterial methohexital administration during electroconvulsive therapy (ECT) prompted the protocol development.
• The proposed protocol involves early subcutaneous enoxaparin administration at prophylactic doses.
• Additional components include warm compresses and close neurovascular monitoring.

Main Results:

• The protocol aims to reduce the incidence and severity of thrombotic complications.
• It seeks to prevent the progression of vascular damage to tissue necrosis and gangrene.

Conclusions:

• The proposed protocol offers a contemporary approach to managing accidental intra-arterial barbiturate injections.
• Early intervention with enoxaparin, supportive care, and vigilant monitoring is crucial for improving patient outcomes.