A case of total spinal anesthesia

Asfaw, Gebrehiwot; Eshetie, Atalay

doi:10.1016/j.ijscr.2020.09.177

Cited by 9 publications

(7 citation statements)

References 10 publications

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“…For that reason, our patients were closely monitored and were not released from the hospital until the next day. Cases described in the literature report onset of the spinal block shortly after drug administration [ 9 ]. However, this was not the case in those patients where catheter placement with continuous drug administration was involved.…”

Section: Discussionmentioning

confidence: 99%

Epidural Blood Patch Performed Immediately After Dural Puncture and Epidural Drug Administration

Galanou¹,

Tsoleridis²,

Tsoleridis³

2021

Cureus

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The epidural blood patch (EBP) is a solution for persistent headaches following an accidental dural puncture. We report three cases where EBP was performed immediately after dural puncture combined with drug administration for lumbago. To the best of our knowledge, no similar cases have been reported in the literature.The patients provided their informed consent, and all standard protocols were followed. At the moment of the dural puncture, all the patients manifested severe headaches, nausea, vomiting, and profuse sweating. A second epidural puncture was performed at a higher intervertebral space, followed by drug administration and 20 mL of autologous blood. All the patients improved gradually, while their headaches vanished after 30-35 minutes. The patients were kept in for monitoring and released the following day with specific instructions and daily phone contact for a week without any complications. Their lumbago symptoms regressed.The possibility of pneumocephalus was excluded because of the patients' symptomatology. The risk of high or total spinal anesthesia due to local anesthetic leakage subarachnoidally was countered with close monitoring of the patients. EBP complications include failure, postdural-puncture headache worsening by an accidental additional dural tear(s), back pain, and infection. All patients were instructed to report any symptoms immediately. EBP executed immediately after dural puncture seems to relieve headache fast and does not appear to impede epidural analgesia.

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Section: Discussionmentioning

confidence: 99%

Epidural Blood Patch Performed Immediately After Dural Puncture and Epidural Drug Administration

Galanou¹,

Tsoleridis²,

Tsoleridis³

2021

Cureus

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“…Total spinal following repeat spinal anesthesia: Total spinal can be there due to a high dose of local anesthetic if due precautions are not taken. If not detected and treated in time, the patient may develop cardiac arrest [33].…”

Section: Intrinsic Cardiac Reflexesmentioning

confidence: 99%

Cardiac Arrest Following Central Neuraxial Block

Kulkarni¹,

Futane²

2023

Updates in Anesthesia - The Operating Room and Beyond

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Central neuraxial blocks (CNB) are used worldwide in anesthesia practice. They are safe, however, not devoid of untoward complications. Cardiac arrest (CA) is one of the major devastating complications. The anesthesiologists are concerned about CA as it can occur unexpectedly and suddenly even in a young ASA grade I patient, undergoing elective surgery, at any time during and after administration of CNB in spite of continuous vigilance. A better understanding of the physiology of CNB, availability of monitoring devices, and safer local anesthetic drugs contribute to reduced mortality, yet cases of CA are reported even recently. These case reports provide information relevant to particular incidents and may be inadequate to provide comprehensive information to explain the overall clinically important aspects related to CA following CNB. This chapter would provide a summary and analysis of the current recommendations about etiology, predisposing factors, preventive measures, and various measures tried for the treatment of cardiac arrest, although the exact etiology and predisposing factors are still not known. The comprehensive information would be helpful for anesthesiologists during day-to-day practice and to increase the safety of patients undergoing CNB. Proper patient selection, pre-/co-loading of fluids, the modifying technique of CNB as per patient’s need, early use of epinephrine during bradycardia refractory to atropine, continuous monitoring, vigilance during intra- and postoperative period would help in prevention, early detection, and prompt treatment of CA. Challenges faced by anesthesiologists during CNB practice and newer modalities used for the treatment of refractory CA are also discussed. The mystery of sudden unexpected CA is yet to be solved and research in this direction is warranted. Electronic medical record keeping and reporting untoward incidence to the national board will also help to improve patient safety in the future.

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“…If high spinal anesthesia occurs, placing the patient in a Trendelenburg position will likely increase venous return and improve cardiac output. However, if the parturient has a high spinal, the Trendelenburg position is not recommended as it can cause a further rise of the hyperbaric local anesthetic block that can progress to a total spinal 71 …”

Section: Complications Such As Failed Epidural and High Spinal Blockmentioning

confidence: 99%

“…70 The unintended cephalad spread of local anesthetic in the subarachnoid space can induce a sudden decrease in blood pressure, rapidly increasing motor block, temporary loss of breathing, loss of consciousness, dilated pupils, apnea, and even cardiac arrest. 71 The volume of local anesthetics injected in susceptible patients such as obstetric patients of short stature, old age, and particularly parturients with obesity needs to be reduced to minimize the incidence of high neuraxial blockade. The incidences vary between 1:2971 and 1:16,200 anesthetics; however, guidelines from the United Kingdom suggest an incidence of 1:100,000.…”

Section: Ultrasoundmentioning

confidence: 99%

Neuraxial analgesia, nerve blocks, and special considerations for the parturient

Bapodra,

Moy,

Nekola

et al. 2023

International Anesthesiology Clinics

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A case of total spinal anesthesia

Cited by 9 publications

References 10 publications

Epidural Blood Patch Performed Immediately After Dural Puncture and Epidural Drug Administration

Epidural Blood Patch Performed Immediately After Dural Puncture and Epidural Drug Administration

Cardiac Arrest Following Central Neuraxial Block

Neuraxial analgesia, nerve blocks, and special considerations for the parturient

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