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Intravenous (IV) medication administration error remains a major concern during the perioperative period. This review examines inadvertent IV anaesthesia induction agent administration via high‑risk routes. Using Medline and Google Scholar, the author searched published reports of inadvertent administration via neuraxial (intrathecal, epidural), peripheral nerve or plexus or intracerebroventricular (ICV) route. The author applied the Human Factors Analysis and Classification System (HFACS) framework to identify systemic and human factors. Among 14 patients involved, thiopentone was administered via the epidural route in six patients. Four errors involved the routes of ICV (propofol and etomidate one each) or lumbar intrathecal (propofol infusion and etomidate bolus). Intrathecal thiopentone was associated with cauda equina syndrome in one patient. HFACS identified suboptimal handling of external ventricular and lumbar drains and deficiencies in the transition of care. Organisational policy to improve the handling of neuraxial devices, use of technological tools and improvements in identified deficiencies in preconditions before drug preparation and administration may minimise future risks of inadvertent IV induction agent administration. [ABSTRACT FROM AUTHOR]

Intravenous (IV) medication administration error remains a major concern during the perioperative period. This review examines inadvertent IV anaesthesia induction agent administration via high-risk routes. Using Medline and Google Scholar, the author searched published reports of inadvertent administration via neuraxial (intrathecal, epidural), peripheral nerve or plexus or intracerebroventricular (ICV) route. The author applied the Human Factors Analysis and Classification System (HFACS) framework to identify systemic and human factors. Among 14 patients involved, thiopentone was administered via the epidural route in six patients. Four errors involved the routes of ICV (propofol and etomidate one each) or lumbar intrathecal (propofol infusion and etomidate bolus). Intrathecal thiopentone was associated with cauda equina syndrome in one patient. HFACS identified suboptimal handling of external ventricular and lumbar drains and deficiencies in the transition of care. Organisational policy to improve the handling of neuraxial devices, use of technological tools and improvements in identified deficiencies in preconditions before drug preparation and administration may minimise future risks of inadvertent IV induction agent administration.

General anaesthesia is a temporary state of unconsciousness which is induced to facilitate a therapeutic procedure. Induction is the first stage of a sequential process. It commences with patient preparation and assessment away from theatre then continues in the safe and monitored environment of the anaesthetic room or operating theatre where the administration of drugs and airway interventions take place. The anaesthetic then transits through maintenance, emergence and recovery phases. The exact mechanism of induction, whether it be intravenous, inhalational or rapid sequence induction, depends on the needs of the patient and the procedure planned. As general anaesthesia is seldom a therapeutic intervention in itself, it is essential that inherent risks to the patient be minimized. [ABSTRACT FROM AUTHOR]

General anaesthesia is a temporary state of unconsciousness which is induced to facilitate a therapeutic procedure. Induction is the first stage of a sequential process. It commences with patient preparation and assessment away from theatre then continues in the safe and monitored environment of the anaesthetic room or operating theatre where the administration of drugs and airway interventions take place. The anaesthetic then transits through maintenance, emergence and recovery phases. The exact mechanism of induction, whether it be intravenous, inhalational or rapid sequence induction, depends on the needs of the patient and the procedure planned. As general anaesthesia is seldom a therapeutic intervention in itself, it is essential that inherent risks to the patient be minimized. [ABSTRACT FROM AUTHOR]

General anaesthesia is a temporary state of unconsciousness that is induced to facilitate a therapeutic procedure. Induction is the first stage of a sequential process. It commences with patient preparation and assessment away from theatre, and continues in the safe and monitored environment of the anaesthetic room or operating theatre, where the administration of drugs and airway interventions take place. The anaesthetic then transits through maintenance, emergence and recovery phases. The exact mechanism of induction-whether it be intravenous, inhalational or rapid sequence induction-depends on the needs of the patient and the procedure planned. As general anaesthesia is seldom a therapeutic intervention in itself, it is essential that inherent risks to the patient are minimized. [ABSTRACT FROM AUTHOR]