Leg ischaemia in an infant following accidental intra-arterial administration of atracurium treated with caudal anaesthesia

We describe the effects of accidental inta-arterial injection of suxamethonium and atracurium into the femoral artery of an infant. An 11-month-old boy with Downs Syndrome and obstructive sleep apnoea presented for tonsillectomy. Peripheral venous cannulation proved impossible. A femoral venous line was sited following inhalational induction of anaesthesia. Suxamethonium was given through this line and produced no adverse effect. Subsequently, atracurium was given through the line causing an instant cutaneous flush in the leg followed by a marked ischaemic appearance. The femoral line was assumed to be sited in the femoral artery and was removed. At the end of the operation a caudal injection of 10 ml of 0.25% bupivacaine was performed. Within 30 min there was marked vasodilation of both legs with easily felt peripheral pulses. In view of the tonsillectomy anticoagulant and thrombolytic therapy were contra-indicated. There were no adverse sequelae.