Drainage or lavage as a salvage manoeuvre after intrathecal drug errors: A systematic review with therapeutic recommendations
Authors' conclusion
This review shows that CSF drainage or lavage leads to intrathecal drug removal, but it is unsure if this intervention leads to improved overall patient outcome.
Study context
- Population
- Patients with inadvertent intrathecal drug administration errors treated with cerebrospinal fluid (CSF) drainage or lavage via percutaneous lumbar access (individual patient data reports)24 paediatric cases
- Participants
- 58 patients
- Outcome
- Description and count of CSF drainage or lavage (times and volume of drainage, volume and type of replacement fluid)
Methodological detailsSearch of Embase, Medline, Web of Science, Cochrane Central Register of Randomized Trials and Google Scholar in 2022
- Search of Embase, Medline, Web of Science, Cochrane Central Register of Randomized Trials and Google Scholar in 2022
Pooled result
As reported in the abstract
CSF drainage or lavage methodology
Intrathecal drug removal continued
45%
Further pooled results
Effects (drug removal)
- Cases with effects specifically reported, all demonstrating drug removal
- 27
- Drug removal shown by CSF drug concentrations
- 20
- Drug removal shown by clinical signs
- 7
Overall outcome
- Depended largely on the causative agent
Safety
- Cases in which adverse effects were sought
- 17
- Intracranial haemorrhage
- 3
- Short-term memory impairment up to 6 months (only long-term sequela)
- 1
- No interventions required for these adverse events
Original publication
Drainage or lavage as a salvage manoeuvre after intrathecal drug errors: A systematic review with therapeutic recommendations. J Clin Anesth. Published 14 June 2023. doi:10.
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