• 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  

      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
     
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