Journal of Anaesthesia & Critical Care Case Reports

Vol 4 | Issue 2 | May-Aug 2018 | page: 21-23 | Nadia Awad, Scott Zalut, Evan Deutsch

Authors: Nadia Awad [1], Scott Zalut [2], Evan Deutsch [1]

[1] Division of Vascular and Endovascular Surgery, Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA,

[2] Department of Anesthesiology, Albert Einstein Medical Center, Philadelphia, PA, USA.

Address of Correspondence

Dr. Nadia Awad,
5401 Old York Road, Klein 203,
Philadelphia, PA 19141, USA.
Email: awadnadi@einstein.edu

Abstract

Introduction: Induction of anesthesia relies on multiple factors including appropriate monitoring, administration, and dosing of induction agents. In morbidly obese patients, placement and maintenance of intravenous lines may be difficult and accidental subcutaneous infiltration of medications may be challenging to identify. The treatment of accidental subcutaneous administration of neuromuscular blocking agents may be complex as the absorption and subsequent elimination is altered and not well known, and the inadvertent prolonged dosing could lead to catastrophic complications.

Case Report: We present a case report of the successful management of the accidental subcutaneous administration of rocuronium in a morbidly obese, 65-year-old Caucasian female with multiple comorbidities undergoing an elective endovascular procedure. The perioperative management of the patient is discussed, and a review of the literature is provided.

Conclusion: Relatively little information is available regarding the absorption of medications outside of the typical route of administration. The accidental subcutaneous infiltration of neuromuscular blockers could lead to airway compromise or prolonged blockade due to the unknown onset, peak effect, and duration of action. Open discussion among the many treatment team members after identification of accidental misadministration of medications is critical and clinical acumen is paramount to ensure optimal patient outcomes. Since intravenous line infiltration and subsequent subcutaneous extravasation are not a rare intraoperative event, more research into the effects of neuromuscular blocking agents is needed to aid clinical outcomes.

Keywords: Anesthesia, critical care, drug administration routes, extravasation, neuromuscular blocker.

References

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