What is the term for inflammation of veins after administration of anesthesia?

Phlebitis: The Term for Inflammation of Veins After Administration of Anesthesia

The medical term for inflammation of veins after administration of anesthesia is "phlebitis." This condition is a common complication of intravenous administration that can significantly affect clinical outcomes and patient satisfaction.

Understanding Phlebitis in Anesthesia

Phlebitis is characterized by inflammation of the vein wall, which can occur following the administration of anesthetic agents and other medications through intravenous routes. It represents one of the most frequent complications associated with intravenous cannulation.

Mechanisms and Pathophysiology

Phlebitis typically develops through several mechanisms:

• Chemical irritation: Anesthetic agents and their vehicles (solvents) can directly irritate the venous endothelium
• Mechanical trauma: From the cannula itself
• Infusion-related factors: Including rate, volume, and duration
• Patient-related factors: Such as age, sex, and vascular health

The pathophysiology involves:

• Irritation of the endothelium inducing venoconstriction
• Endothelial dysfunction
• Activation of inflammatory pathways (including nuclear factor kappa B, Wnt/β-catenin, and others) 1
• Upregulation of inflammatory mediators

Clinical Presentation

Phlebitis presents with several characteristic signs and symptoms:

• Feelings of tingling, burning, or discomfort at the injection site
• Pain along the course of the vein
• Swelling and redness at the injection site
• In more severe cases: streak formation, palpable venous cord, and warmth
• Later symptoms may include blistering, necrosis, and ulceration 2

Risk Factors

Several factors increase the risk of developing phlebitis:

• Patient factors:

  • Age over 65 years
  • Female sex 3

• Technical factors:

  • Insertion of cannula into veins on the back of the hand 3
  • Peripheral routes without heparin administration
  • Reuse of the same cannula for both intraoperative and postoperative purposes 4

• Medication factors:

  • Certain anesthetic agents (etomidate has shown a 43% rate of venous complications at 14 days post-administration) 5
  • Intravenous administration of irritant drugs like aminophylline 3

Prevention and Management

Prevention strategies include:

1. Proper cannulation technique:

   • Select appropriate vein size and cannula gauge
   • Avoid veins on the back of the hand when possible

2. Dedicated cannulation:

   • Use of a dedicated cannula for postoperative use decreases the incidence and severity of phlebitis (26.1% vs 63.3% with single cannula) 4

3. Medication considerations:

   • Dilution of irritant medications
   • Appropriate infusion rates
   • Selection of less irritating anesthetic agents when possible

4. Monitoring:

   • Regular assessment of IV sites
   • Early detection and intervention

Differential Diagnosis

It's important to differentiate true phlebitis from:

• Local non-extravasation reactions (erythema around the cannula site, urticaria, local itching)
• Chemical phlebitis (burning sensation at cannula site, cramping along the vein) 2
• Extravasation ("tissuing") - leakage of fluid into surrounding tissues 6

Conclusion

Recognizing phlebitis early is crucial for preventing progression to more serious complications such as thrombophlebitis or venous thrombosis. The daily risk of complications ranges from 15% (day 1) to 30% (6 or more days) for peripheral cannulae 3, highlighting the importance of vigilant monitoring and appropriate preventive measures.