Spinal anesthesia transient neurological

Transient neurological symptoms have been observed in patients after spinal anesthesia (Hampl et al. 1995). Activity and tolerability of new local anesthetics after intrathecal injection were studied in various animal species in order to predict both parameters for spinal (subarachnoid) anesthesia in patients. 

Hampl KF, Schneider MC, Ummenhofer W, Drews J (1995) Transient neurological symptoms after spinal anesthesia. Anesth Analg 81 1148-1153... 

Lambert DH. Transient neurologic symptoms when phenylephrine is added to tetracaine spinal anesthesia—an alternative. Anesthesiology 1998 89(1) 273. 

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. 

Urinary retention as a true transient neurological symptom developed after accidental total spinal anesthesia with mepivacaine, which is often considered to be the best agent for intrathecal anesthesia, owing to its low incidence of transient radicular irritation (268). 

Morisaki H, Masuda J, Kaneko S, Matsushima M, Takeda J. Transient neurologic syndrome in one thousand forty-five patients after 3% lidocaine spinal anesthesia. Anesth Analg 1998 86(5) 1023-6. 

Freedman JM, Li DK, Drasner K, Jaskela MC, Larsen B, Wi S. Transient neurologic symptoms after spinal anesthesia an epidemiologic study of 1,863 patients. Anesthesiology 1998 89(3) 633 1. 

Liguori GA, Zayas VM, Chisholm MF. Transient neurologic symptoms after spinal anesthesia with mepivacaine and lidocaine. Anesthesiology 1998 88(3) 619-23. 

Axelrod EH, Alexander GD, Brown M, Schork MA. Procaine spinal anesthesia a pilot study of the incidence of transient neurologic symptoms. J Clin Anesth 1998 10(5) 404-9. 

Philip J, Sharma SK, Gottumukkala VN, Perez BJ, Slaymaker EA, Wiley J. Transient neurologic symptoms after spinal anesthesia with lidocaine in obstetric patients. Anesth Analg 2001 92(2) 405-9. 

Eberhart LH, Morin AM, Kranke P, Geldner G, Wulf H. Transiente neurologische Symptome nach Spinalanasthesie. Eine quantitative systematische Ubersicht (Metaanalyse) randomisierter kontrollierter Studien. [Transient neurologic symptoms after spinal anesthesia. A quantitative systematic overview (meta-analysis) of randomized controlled studies.] Anaesthesist 2002 51(7) 539 6. 

Pollock JE, Burkhead D, Neal JM, Liu SS, Friedman A, Stephenson C, Polissar NL. Spinal nerve function in five volunteers experiencing transient neurologic symptoms after lidocaine subarachnoid anesthesia. Anesth Analg 2000 90(3) 658-65. 

Adachi Y, Watanabe K, Uchihashi Y, Sato T. [Urinary retention as a transient neurologic symptom after accidental total spinal anesthesia with mepivacaine hydrochloride..] Masui 1999 48(9) 1009-10. 

There have been responses to last year s report of occurring after the addition of phenylephrine to tetracaine spinal anesthesia. It has been suggested that sodium bisulfite, a preservative in phenylephrine solutions for injection, may have been responsible for transient neurological symptoms that have been observed in some patients (7). However, the original authors rejected this, since the dose of bisulfite was small and since there is uncertain evidence whether the compound is neurotoxic in any case. Another correspondent commented that tetracaine itself may be more toxic than other local anesthetics the authors did not address this point in their reply (8). 

Edomwonyi NP, Isesele TO. Transient neurological symptoms following spinal anesthesia for cesarean section. Middle East J Anesthesiol 2010 20 809-13. 

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