We have what is called a third table list....small cases under local or regional anesthesia...there was an 8 yr old girl with a diffuse, non pinchable swelling in the chin area. After confirming it was not vascular, we decided for better or worse, to do a liposuction with fine cannulae.
Having just completed a regional and nerve block course(!), we decided we could do this under mental nerve blocks. In the recovery room, with the mother holding the hand of the child, I blocked both the mental nerves, intra orally. A combo of lignocaine, sensorcaine and adrenaline, using a 30# needle. It worked like a charm, and after a short while we took the patient in.
We proceeded with the lipo, after about 15 to 20 mins the child started saying that she could feel things. So I gave a top up, of the same cocktail....
The second the last of the local was injected, she took a deep breath...and stopped breathing. I immediately alerted the anesthetist who bagged the patient, then intubated her...in 5 mins she had a generalised convulsion. She was ventilated for 15 mins, extubated, sent to the recovery, where I explained to the parents that we had an adverse effect, and we had to cut short the procedure. End of this story, she was absolutely fine, came back after 3 months for a formal procedure under GA.
Naturally we had some furious discussions, and it didn't require an Einstein to conclude it was an intravascular injection...which raised some secondary questions....one doesn't ask the boss if he aspirated before injecting!!!
I told all concerned, that aspiration is like breathing....it is automatic after a few years.
I have been rambling but I am arriving at the point....
Aspiration is NOT the proper way to ensure you are not in a vessel...with needles smaller than 26G, any aspiration will cause the vessel to collapse and block the needle. The ONLY way is to place the needle, and look for staining of blood in the hub. If there is staining, change the position, and if possible, the needle.
I learned a valuable lesson, without paying the price for it. I thanked my guardian angel, and vowed to be more careful in future.
Mukund Jagannathan
