EAS Publisher | Accidental Intrathecal Injection of Tranexamic Acid during Emergency Cesarean Section: A Case Report

Accidental Intrathecal Injection of Tranexamic Acid during Emergency Cesarean Section: A Case Report

DOI : https://doi.org/10.36349/easjacc.2025.v07i06.020

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Introduction: Accidental intrathecal injection of tranexamic acid (TXA) is a rare but potentially fatal medication error responsible for severe neurotoxicity. It most often results from drug ampoule confusion during spinal anesthesia. Case Presentation: We report the case of a 40-year-old ASA II woman admitted for semi-urgent cesarean section under spinal anesthesia. Due to a medication error, 150 mg of tranexamic acid was inadvertently injected intrathecally after confusion with hyperbaric bupivacaine. General anesthesia was immediately induced to allow fetal extraction. Approximately forty-five minutes after the accidental injection, the patient developed generalized tonic–clonic seizures refractory to midazolam. Management consisted of a combination of thiopental, midazolam, a volatile anesthetic agent, and cerebrospinal fluid lavage–drainage. The clinical outcome was favorable, with a normal neurological examination one month later. Conclusion: This case highlights the severity of accidental intrathecal tranexamic acid injection and emphasizes the need for strict preventive measures to avoid medication errors in anesthesia.

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