[Convulsions and cardiac arrest after epidural anesthesia. Prevention and treatment]

Seizures followed by cardiac arrest after obstetrical epidural anaesthesia are induced by either low cerebral perfusion due to cardiovascular collapse after too excessive sympathetic blockade or after accidental total spinal anaesthesia, or by toxic accident due to accidental intravascular administration of local anaesthetic drugs. In case of toxic accident, convulsions usually occur before haemodynamic changes. Whatever the mechanism of the accident, excessive sympathetic blockade or toxic accident, when epidural anaesthesia is performed with lidocaine, bradycardia with normal QRS complexes occurs. Respiratory depression has to be treated and ephedrine has to be administered. In contrast, when bupivacaine is used, in case of toxic accident, there are dysrhythmias or bradycardia but QRS complexes are widened. The treatment is firstly to oxygenate, to stop convulsions and then to intubate the trachea and to ventilate the lungs.