Case 51: An “Old Trick” but a Potential Serious Problem

Abstract

You have anesthetized an 18-month-old child with a facial deformity which requires surgical correction. He is otherwise healthy and is classified as an ASA 1. Unfortunately, there is more blood loss than anticipated, and the blood pressure is beginning to drop to nearly unacceptable levels. You call for blood and start infusing albumin 5% (250 ml glass bottle), but it is going very slowly through your 22 G IV in the hand. By aspirating 20 ml albumin from the albumin bottle via an in-line stopcock, in the IV administration set, you are able to inject the albumin more rapidly into the patient. But this is time-consuming, minimizes your ability to observe the vital signs, and can potentially damage the vein leading to extravasation.