Spinal anesthesia, apnea with

A 68-year-old man developed total spinal anesthesia after the administration of 20 ml of ropivacaine 1% without a prior test dose via an epidural catheter, which was inadvertently placed intrathecally (83). Initial aspiration of both the Touhy needle and the catheter failed to identify the intrathecal position of the catheter. The patient noted weakness in his right leg immediately after the end of the injection. This was followed by weakness in his right arm, asystole, apnea, and loss of consciousness. Ventricular escape beats were noted and sinus rhythm returned after mask ventilation with 100% oxygen and the administration of atropine 1 mg and ephedrine 50 mg. He was able to open his eyes, but remained apneic and was therefore intubated and ventilated. Cardiovascular stabihty was maintained with incremental boluses of ephedrine to a total of 60 mg. He regained consciousness and was successfully extubated 145 minutes later. AH sensory and motor deficits had resolved within 8 hours and no neurological deficit or transient neurological symptoms were detected 5 days later. 

There is a potential risk that spinal anesthesia will cause apnea in premature infants. However, spinal anesthesia with a sound technique has been used safely in high-risk infants. Tetracaine was used in 142 such cases only two infants had serious adverse effects, one with unexplained but treatable apnea and one in whom too high a block resulted in respiratory arrest (196). 

Inadvertent spinal anesthesia and subsequent nervous system toxicity, for example with transient paralysis or apnea, are the main complications of stellate ganglion block (SEDA-22, 140). It has been suggested that ultrasound guidance when performing the block might improve safety (357). The use of very small test doses and an anterior approach to the stellate ganglion are recommended preventive measures. 

Respiratory The risk of postoperative spells of apnea in preterm infants has promoted the use of spinal anesthesia, because of improved safety. However, high spinal anesthesia has been associated with respiratory failure in a preterm infant [33" ]. The authors concluded that the cephalad spread of spinal anesthesia is less... 

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See also in sourсe #XX -- [ ]

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