During induction, thiopentone is inadvertently injected partially into the radial artery. The patient complains immediately of severe forearm pain. Which immediate step is most appropriate?
- A Leave the needle in situ, flush with saline, and consider dilute papaverine or lignocaine through the catheter ✓
- B Apply a tight arterial tourniquet proximal to the injection site for 20 minutes
- C Inject heparin 5000 units undiluted into the artery to prevent thrombosis
- D Apply ice packs and observe, since injury resolves spontaneously in most cases
Correct answer: A. Leave the needle in situ, flush with saline, and consider dilute papaverine or lignocaine through the catheter
Explanation
Intra-arterial thiopentone causes intense vasoconstriction, endothelial injury and crystal deposition leading to thrombosis and possible gangrene. Management begins with stopping the injection but keeping the needle in place to allow flushing with saline, dilute vasodilator such as papaverine, or local anaesthetic. Sympathetic blockade with stellate ganglion block and heparinisation may follow. Removing the needle wastes access, a proximal tourniquet worsens distal ischaemia, and passive observation risks limb loss.
Reference: Miller's Anesthesia, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.