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When a routine procedure results in tragedy.

Gabor B Racz on March 29, 2022 at 7:16 am
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    • Gabor B RaczGabor B Racz
      Participant
      Joined: Mar 28, 2016
      Posts: 30
      #72855

      Natural progression of medicine is change for the better. It took the unfortunate death of a patient to understand why. Returning from vacation, I was notified of a cesarean section which resulted in a cardiac arrest. When reviewing the case, we questioned why using .75% Bupivacaine-Marcaine as standard of care at that time would cause this to happen. Dr. George Albright collected 13 cases including ours, the FDA got involved and took the .75% medication off the market. Analyzing the catheter we commonly used at the time, it had a tendency to kink which made aspiration meaningless, but they were cheaper. Nevertheless, we had to question the mechanics of how we got the tip of the catheter into the peridural vein by perforation, which then tracked into the heart to depress the myocardium. This is what caused the arrest that was hard to reverse. The catheter lacked kink resistance and a non-perforating tip. Partial success was not enough because the young mother passed away within a couple of weeks. To save lives of countless others comes with a price (which then created a series of new spring-reinforced catheters, unkinkable and soft tipped, commonly known as the Racz Catheter). The cost of life must be the priority.

      • Natalie Lucas
    • Gabor B RaczGabor B Racz
      Participant
      Joined: Mar 28, 2016
      Posts: 30
      #72856

      Similar to the case described above, an improvement to the standard of care is moving forward regarding the types of needles used for injections. There is overwhelming evidence where the FDA should not only be involved with drugs, but also in the use of sharp vs blunt needles. Our animal data clearly shows that blunt needles do not perforate nerves or arteries. In anesthetized dogs the incidence of problems is somewhere around 10,000+ cases, but it is randomly occurring which means you could have 2 in 2 weeks, 2 months, 2 years or never. I have defended a doctor who had 2 intravertebral artery injections and some very serious complications. Many transforaminal, stellate ganglion, subdural and intra-cord injection related complications. The neurosurgeons gave up over 50 years ago on the use of sharp needles for brain related injections.

      Recently the likely consequence of an intraneural injection was the development of a Brown-Sequard Cord Infarction (ipsilateral weakness and contralateral numbness). To date still have not heard of a blunt needle causing distant injuries or infarction nor have I heard of intra-arterial injections caused by blunt needle.

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