Inadvertent Intra-Arterial Methohexital Injection During Procedural Sedation: A Case Report and Contemporary Perspective.

Barbiturates have historically played a significant role in clinical anesthesia and sedation, accompanied by a variety of medication use warnings. Early case reports discussed severe complications of accidental intra-arterial injections of certain barbiturates, including thrombosis progressing to tissue necrosis and gangrene. While management strategies have been explored, no contemporary recommendations are available in the literature. Following a recent case of intra-arterial methohexital administration during electroconvulsive therapy (ECT), we propose a protocol that includes early use of subcutaneous enoxaparin at standard prophylactic dosing, warm compresses, and close neurovascular monitoring to reduce thrombotic complications and prevent progression to tissue damage.