During rapid sequence induction, part of a thiopentone dose is accidentally injected into the radial artery. The patient immediately complains of severe burning pain and the hand blanches. The correct immediate management is:
- A Inject hyaluronidase around the puncture site and elevate the limb
- B Withdraw the needle immediately and apply warm compresses alone
- C Leave the cannula in situ, dilute the drug with saline through it, inject papaverine or lignocaine intra-arterially, heparinise and perform a stellate ganglion block ✓
- D Proceed with surgery and reassess the hand after 24 hours
Correct answer: C. Leave the cannula in situ, dilute the drug with saline through it, inject papaverine or lignocaine intra-arterially, heparinise and perform a stellate ganglion block
Explanation
Thiopentone is highly alkaline (pH about 10.5) and crystallises in arterioles, causing endothelial injury, intense vasospasm and potential gangrene. Treatment requires stopping the injection, leaving the cannula to dilute the crystallised drug, intra-arterial papaverine or lignocaine, systemic heparinisation, and sympathetic blockade with a stellate ganglion or brachial plexus block to abolish spasm and improve collateral flow.
Reference: Morgan and Mikhail's Clinical Anesthesiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.