Management of a spinal catheter that became intravascular

The management of a misplaced spinal catheter in an 83-year-old women undergoing elective knee surgery, in whom clear cerebrospinal fluid and blood were alternately aspirated through the catheter during the surgical procedure, is described. In the face of catheter misplacement, before administering general anesthesia, the authors recommend using a small "test dose" of local anesthetic to confirm subarachnoid location of catheter despite lack of frank reflux of cerebrospinal fluid.