Case Report

The Unique Management of Accidental Intra-Arterial Injection of Propofol in a Patient with Acute Subdural Hemorrhage: A Case Report

Abstract

Propofol is a commonly used medication for sedation during surgery; however, it must be used with precaution in neurologic patients because of the subsequent adverse effects of cardiovascular and neurologic.
An 83-year-old male patient with acute subdural hemorrhage was referred with a two-year history of falling and a recent occurrence of imbalance; the patient underwent urgent surgery under general anesthesia, using 100 µg fentanyl for premedication, 50 mg Propofol for induction, and Isoflurane gas and fentanyl drip for maintenance. During transmission of the patient for postsurgical computed tomography, two ccs Propofol 1% were mistakenly injected into the patient's radial artery and managed appropriately by the master. Following this management, the patient represented no alteration in his vital signs and was discharged in a favorable condition. Here, we report how this case could be managed successfully.
Robust data regarding the complications of accidental administration of Propofol through an artery are lacking, and the presented results remain controversial. The authors have herby drawn attention to the unique management of an accidental intra-arterial injection of Propofol. Further studies are warranted to establish definite conclusions.

[1] Ellett ML. Review of propofol and auxiliary medications used for sedation. Gastroenterology Nursing. 2010; 33(4):284-95.
[2] Schraag S, Pradelli L, Alsaleh AJO, Bellone M, Ghetti G, Chung TL, et al. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. BMC anesthesiology. 2018; 18(1):1-9.
[3] Feng AY, Kaye AD, Kaye RJ, Belani K, Urman RD. Novel propofol derivatives and implications for anesthesia practice. Journal of anaesthesiology, clinical pharmacology. 2017; 33(1):9.
[4] Sahinovic MM, Struys MM, Absalom AR. Clinical pharmacokinetics and pharmacodynamics of propofol. Clinical pharmacokinetics. 2018; 57(12):1539-58.
[5] Lu L, Xiong W, Zhang Y, Xiao Y, Zhou D. Propofol-induced refractory status epilepticus at remission age in benign epilepsy with centrotemporal spikes: A case report and literature review. Medicine. 2019; 98(27).
[6] Finsterer J, Frank M. Propofol is mitochondrion-toxic and may unmask a mitochondrial disorder. Journal of child neurology. 2016; 31(13):1489-94.
[7] Guntani A, Yoshiga R, Mii S. A case of suspected propofol infusion syndrome after abdominal aortic aneurysm surgery. Surgical Case Reports. 2020; 6(1):1-4.
[8] Krajčová A, Waldauf P, Anděl M, Duška F. Propofol infusion syndrome: a structured review of experimental studies and 153 published case reports. Critical Care. 2015; 19(1):1-9.
[9] Terashima S, Muroya T, Ikegawa H, Kajino K, Sakuramoto K, Yui R, et al. Propofol suppresses ventricular arrhythmias: a case report of acute caffeine intoxication. Acute Medicine & Surgery. 2020; 7(1):e514.
[10] Perel A. Non-anaesthesiologists should not be allowed to administer propofol for procedural sedation: a Consensus Statement of 21 European National Societies of Anaesthesia. European Journal of Anaesthesiology| EJA. 2011; 28(8):580-4.
[11] Burtea DE, Dimitriu A, Maloş AE, Săftoiu A. Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy. World journal of gastrointestinal endoscopy. 2015; 7(10):981.
[12] Lokoff A, Maynes JT. The incidence, significance, and management of accidental intra-arterial injection: a narrative review. Can J Anaesth. 2019; 66(5):576-592.
[13] Lake C, Beecroft CL. Extravasation injuries and accidental intra-arterial injection. Continuing Education in Anaesthesia, Critical Care & Pain. 2010; 10(4):109-13.
[14] Shenoi AN, Fortenberry JD, Kamat P. Accidental intra-arterial injection of propofol. Pediatr Emerg Care. 2014; 30(2):136.
[15] Dinis-Oliveira RJ. Metabolic profiles of propofol and fospropofol: clinical and forensic interpretative aspects. Biomed Res Int. 2018; 2018.
[16] Fontes RB, Smith AP, Muñoz LF, Byrne RW, Traynelis VC. Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center. J Neurosurg. 2014; 121(2):307-12.
[17] Yan L-M, Chen H, Yu R-G, Wang Z-H, Zhou G-H, Wang Y-J, et al. Emergence agitation during recovery from intracranial surgery under general anaesthesia: a protocol and statistical analysis plan for a prospective multicentre cohort study. BMJ open. 2015; 5(4).
[18] Kjaergaard M, Rovsing ML. Accidental intra-arterial propofol injection. Ugeskrift for laeger. 2010;172(18):1383-4.
[19] Mitani S, Ishiyama T, Matsukawa T. Inadvertent intraarterial injection of propofol in a patient under general anesthesia. J Anesth. 2009; 23(2):307.
[20] Simonato D, Ganau M, Feltracco P, Causin F, Munari M, Bortolato A. Mechanical thrombectomy in a pediatric patient with sedation aided by contralateral intra-arterial propofol injection: feasibility in an extreme condition. Childs Nerv Syst. 2021; 37(5):1785-1789.
Files
IssueVol 9 No Supp. 2 (2023): Supplement 2 QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/aacc.v9i6.14458
Keywords
Propofol Propofol infusion syndrome Adverse effects Case management Hematoma Subdural Intracranial

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Ferdosnia A, Ramezani M, Mirahmadi Eraghi M, Seifipour S, Javadi SAH. The Unique Management of Accidental Intra-Arterial Injection of Propofol in a Patient with Acute Subdural Hemorrhage: A Case Report. Arch Anesth & Crit Care. 2023;9(Supp. 2):562-565.