Reactions 1434 - 12 Jan 2013

SBupivacaine

Total spinal block: case reportA 26-year-old woman experienced total spinal block while

receiving bupivacaine for spinal anaesthesia.The woman was in labour and had received epidural

anaesthesia; after 12 hours of labour she had failed to progressand was scheduled for caesarean section. She received spinalanaesthesia with bupivacaine 10.5mg given via subarachnoidinjection; she had received her last bolus of bupivacaine 0.25%5mL [route not clearly stated] 90 minutes before spinalanaesthesia. Ten minutes after administration of thesubarachnoid injection, she started to panic and reporteddifficulty breathing. Respiratory arrest occurred and she lostconsciousness.

The woman was intubated, positive pressure ventilation wasstarted and anaesthesia was maintained with nitrous oxide andsevoflurane. Phenylephrine infusion was given continuously. Ababy was delivered 20 minutes after the subarachnoidinjection. The woman was woken and extubated 1 hour laterwithout complication.

Author comment: "For our patient, no boluses wereadministered in the 90 minutes before spinal, bupivacainedose was reduced (10.5mg instead of 12.75mg), and she stilldeveloped total spinal block requiring tracheal intubation."Siddik-Sayyid SM, et al. Total spinal block after spinal anesthesia followingongoing epidural analgesia for cesarean delivery. Journal of Anesthesia 26: 312-3,No. 2, Apr 2012. Available from: URL: http://dx.doi.org/10.1007/s00540-011-1302-5 - Lebanon 803081850

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Reactions 12 Jan 2013 No. 14340114-9954/10/1434-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved