Inadvertent Intrathecal Administration of Digoxin, with Review of the Literature
While the systemic effects of digoxin have been studied, limited data exist on the effects of neuraxial administration. Prior case reports document how digoxin and lidocaine share indistinguishable vials and were inadvertently stocked together in spinal and epidural anesthesia kits, necessitating a...
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2023/4034919 |
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| _version_ | 1850159678058659840 |
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| author | Burton J. Tabaac Ian O. T. Laughrey Hany F. Ghali |
| author_facet | Burton J. Tabaac Ian O. T. Laughrey Hany F. Ghali |
| author_sort | Burton J. Tabaac |
| collection | DOAJ |
| description | While the systemic effects of digoxin have been studied, limited data exist on the effects of neuraxial administration. Prior case reports document how digoxin and lidocaine share indistinguishable vials and were inadvertently stocked together in spinal and epidural anesthesia kits, necessitating a need for further implementation of safety measures. Here, we report the poor progression and brain death of a postpartum woman after accidental administration of intrathecal digoxin during a routine elective cesarean section (C-section). It is imperative that quality improvement and safety measures are taken to avoid the recurrence of this medical error. |
| format | Article |
| id | doaj-art-b32b7b6d45be47378ea38c2ce25c1709 |
| institution | OA Journals |
| issn | 2090-6676 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-b32b7b6d45be47378ea38c2ce25c17092025-08-20T02:23:27ZengWileyCase Reports in Neurological Medicine2090-66762023-01-01202310.1155/2023/4034919Inadvertent Intrathecal Administration of Digoxin, with Review of the LiteratureBurton J. Tabaac0Ian O. T. Laughrey1Hany F. Ghali2University of Nevada, RenoUniversity of Nevada, RenoDepartment of Intensive CareWhile the systemic effects of digoxin have been studied, limited data exist on the effects of neuraxial administration. Prior case reports document how digoxin and lidocaine share indistinguishable vials and were inadvertently stocked together in spinal and epidural anesthesia kits, necessitating a need for further implementation of safety measures. Here, we report the poor progression and brain death of a postpartum woman after accidental administration of intrathecal digoxin during a routine elective cesarean section (C-section). It is imperative that quality improvement and safety measures are taken to avoid the recurrence of this medical error.http://dx.doi.org/10.1155/2023/4034919 |
| spellingShingle | Burton J. Tabaac Ian O. T. Laughrey Hany F. Ghali Inadvertent Intrathecal Administration of Digoxin, with Review of the Literature Case Reports in Neurological Medicine |
| title | Inadvertent Intrathecal Administration of Digoxin, with Review of the Literature |
| title_full | Inadvertent Intrathecal Administration of Digoxin, with Review of the Literature |
| title_fullStr | Inadvertent Intrathecal Administration of Digoxin, with Review of the Literature |
| title_full_unstemmed | Inadvertent Intrathecal Administration of Digoxin, with Review of the Literature |
| title_short | Inadvertent Intrathecal Administration of Digoxin, with Review of the Literature |
| title_sort | inadvertent intrathecal administration of digoxin with review of the literature |
| url | http://dx.doi.org/10.1155/2023/4034919 |
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