• Anaesthesia · Jul 2019

    Editorial Comment

    Spinal tranexamic acid - a new killer in town.

    A sobering editorial...

    • Since 2009 there has been a dramatic increase in reported cases of intrathecal tranexamic acid (TXA), parallel to increasing intraoperative TXA use.
    • TXA is powerfully neurotoxic.
    • Spinal TXA has a mortality rate > 50%, and high incidence of permanent neurological injury in survivors.
    • Almost always results from a drug swap error.
    • Because both TXA and bupivacaine are made by many manufacturers, there are many different ampoule designs and drug presentations.
    • Risk of harm from TXA error is probably ~ 1 in 10,000 spinals.
    • TXA should be physically separated from common spinal drugs and we should consider discarding orphaned ampoules rather than attempting to return to the box.
    • Stop and visualise the consequences after your own theoretical spinal drug error: facing the patient, family, colleagues, hospital, regulators...
    summary
    • A Palanisamy and S M Kinsella.
    • Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
    • Anaesthesia. 2019 Jul 1; 74 (7): 831-833.

    no abstract available

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    This article appears in the collection: Inadvertent spinal tranexamic acid: a devastating error.

    Notes

    summary
    1

    A sobering editorial...

    • Since 2009 there has been a dramatic increase in reported cases of intrathecal tranexamic acid (TXA), parallel to increasing intraoperative TXA use.
    • TXA is powerfully neurotoxic.
    • Spinal TXA has a mortality rate > 50%, and high incidence of permanent neurological injury in survivors.
    • Almost always results from a drug swap error.
    • Because both TXA and bupivacaine are made by many manufacturers, there are many different ampoule designs and drug presentations.
    • Risk of harm from TXA error is probably ~ 1 in 10,000 spinals.
    • TXA should be physically separated from common spinal drugs and we should consider discarding orphaned ampoules rather than attempting to return to the box.
    • Stop and visualise the consequences after your own theoretical spinal drug error: facing the patient, family, colleagues, hospital, regulators...
    Daniel Jolley  Daniel Jolley
     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…