A case of total spinal anesthesia

In situations where the time to delivery is urgent, but not critical within minutes, and otherwise contraindicated spinal anesthesia is the safer option of avoiding the risks and complications of general anesthesia, mainly difficult airway and risks of pulmonary aspiration.

A 35 years old woman (Gravida-7, para 6) having an emergency cesarean section under spinal anesthesia for the indication of cephalopulvic disproportion (CPD). Spinal anesthesia given at L3/L4, with a sensory block of T-4, the fetus delivered uneventfully. Meanwhile, the mother complains difficulty of breathing, developed hypotension, bradycardia, hypoxia, and loss of consciousness. Immediate maternal resuciation done with vasopressor support, endotracheal intubation, and mechanical ventilation. Over a week, the patient progressively regained motor and sensory functions and discharged without any neurological or clinical sequelae.

Total spinal anesthesia is an uncommon incident that can happen during epidural anesthesia, caudal anesthesia, spinal anesthesia, lumbar plexus block, paravertebral block, stellate ganglion block, interscalene brachial blocks, and other regional anesthesia techniques performed at or near to the vertebral column. Often characterized by a sudden decrease in blood pressure, rapidly increasing motor block, difficulty of breathing, loss of consciousness, dilated pupils, apnea, and even cardiac arrest.

Unexpected total spinal anesthesia during neuraxial anesthesia can produce devastating consequences. Precautionary measures should be made during the conduct of regional anesthesia for high-risk patients and early identification and immediate intervention should be applied.