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International Pain and Spine Intervention Society Emergency Protocols: Intra-arterial Injection.
Nathaniel M Schuster1, Stephan Klessinger2, Patrick H Waring3
1Center for Pain Medicine, Department of Anesthesiology, University of California San Diego Health System, La Jolla, CA, USA.
Inadvertent intra-arterial injection during spine procedures can cause severe neurological damage. This protocol outlines immediate steps to recognize and manage these critical events, improving patient outcomes.
Area of Science:
- Interventional Neuroradiology
- Neurology
- Spine Surgery
Background:
- Inadvertent intra-arterial injection is a recognized risk during spine interventions.
- Complications include stroke, seizure, spinal cord infarction, and paralysis.
- Particulate steroid embolism and arterial vasospasm are significant dangers, especially with transforaminal injections.
Purpose of the Study:
- To outline a protocol for the immediate recognition and management of inadvertent intra-arterial injection during spine interventions.
- To detail critical steps to mitigate severe neurological complications.
Main Methods:
- Immediate recognition of potential intra-arterial injection.
- Termination of the procedure.
- Activation of institutional stroke protocols.
- Neurologic assessment and airway management.
- Rapid transfer for advanced neurologic care.
Main Results:
- The protocol aims to minimize neurological deficits associated with inadvertent arterial injection.
- Prompt management can reduce the severity of complications like stroke and paralysis.
Conclusions:
- A standardized protocol is crucial for managing inadvertent intra-arterial injection during spine interventions.
- Rapid response and advanced care are essential for improving patient outcomes and preventing permanent neurological damage.
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