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///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-05:00

Novel use of Magnesium to treat Refractory Status Epilepticus after accidental intrathecal injection of tranexamic acid

Abstract Number: S-16
Abstract Type: Case Report/Case Series

David M Hatch MD, MBA1 ; Medge Owen MD2; Emily Herschmiller MD3; Evans A Narh FRCA4; A J Olufolabi FRCA5

We present a case of accidental injection of tranexamic acid during spinal anesthesia for an elective caesarian section that was effectively treated with magnesium sulfate after other appropriate interventions failed. Immediately following intrathecal injection of 2 ml of solution, the patient complained of severe back pain, followed by muscle spasm and tetany. After failure of spinal anesthesia, a used ampule of tranexamic acid was found on the spinal tray, having similar appearance to the vial of 0.5% hyperbaric bupivacaine. General anesthesia was induced. Muscle spasm and tetany persisted until non-depolarizing neuromuscular blockade was administered. Hemodynamic instability, ventricular tachycardia, and status epilepticus developed, which were refractory to phenytoin, diazepam, thiopental infusion, midazolam infusion, and amiodarone infusion. Magnesium sulfate was then administered postoperatively in the ICU, which successfully terminated her seizures. Unfortunately, the patient’s condition deteriorated on postoperative day three and she died after suffering a cardiopulmonary arrest due to mechanical complications unrelated to her treatment. This is the first report describing the use of magnesium sulfate to terminate refractory status epilepticus due to intrathecal tranexamic acid.

SOAP 2015