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- Olfa Kaabachi, Mongi Eddhif, Karim Rais, and Mohamed Ali Zaabar.
- Department of Anaesthesiology and Intensive Care, Kassab Orthopaedic Institute of Tunis, Tunisia.
- Saudi J Anaesth. 2011 Jan 1; 5 (1): 90-2.
AbstractSome factors have been identified as contributing to medical errors such as labels, appearance, and location of ampules. In this case report, inadvertent intrathecal injection of 80 mg tranexamic acid was followed by severe pain in the back and the gluteal region, myoclonus on lower extremities and agitation. General anesthesia was induced to complete surgery. At the end of anesthesia, patient developed polymyoclonus and seizures needing supportive care of the hemodynamic, and respiratory systems. He developed ventricular tachycardia treated with Cordarone infusion. The patient's condition progressively improved to full recovery 2 days after. Confusion between hyperbaric bupivacaine and tranexamic acid was due to similarities in appearance between both ampules.
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