Equis ISSN 2398-2977

Carotid artery: intracarotid injection

Introduction

  • Due to the close proximity of the common carotid artery to the jugular vein accidental intracarotid injection is a real hazard.
  • Cause: misdirected injection.
  • Signs: acute cerebral disturbance occurs with a violent reaction within 30 seconds of injection; signs range from unprovoked activity in the standing animal to recumbency and loss of consciousness.
  • Treatment: symptomatic.
  • Prognosis: most affected animals recover in minutes, although prolonged coma, convulsions and death occasionally occur.

Pathogenesis

Etiology

  • Most drugs commonly used intravenously can cause this reaction when injected intracarotid.
  • Those incriminated include:
  • Phenothiazine tranquilizers (eg acetyl promazine   Cyclosporine  ).
  • Barbiturates.
  • Chloral hydrate .
  • Xylazine   Xylazine  .
  • Phenylbutazone   Phenylbutazone  .
  • Calcium gluconate.
  • Oxalic and malonic acids.
  • Sodium iodide.

Pathophysiology

  • Intravenous injection into jugular vein is misdirected and intracarotid injection occurs due to proximity of the two structures.
  • Injected material may travel in the carotid distribution to the ipsilateral forebrain   →   acute cerebral disturbance   →   signs ranging from unprovoked kicking, running and headshaking to recumbency and coma.
  • Acute cerebral ischemia occurs with marked edema, vascular endothelial damage and hemorrhage, and neuronal degeneration.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Harkins J D et al (1992) Catherization of the carotid artery in horses using ultrasonography. Equine Vet J 24, 480-481 VetMedResource.

Other sources of information

  • Dr Steve Adair MS DVM DipACVS, University of Tennessee, College of Veterinary Medicine, Department of Large Animal Clinical Sciences, PO Box 1071, Knoxville, TN 37901-1071, USA.


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