| Total Spinal Anesthesis as a Complication of Epidural Anesthesia . |
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Ae Ra Kim, Jae Kyu Jeon |
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Department of Anesthesiology, Presbyterian Medical Center, Keimyung University School of Medicine, Taegu, Korea. |
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| Abstract |
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Total spinal analgesia is a well documented complication of attempted epidural analgesia. We report here one case of accidental total spinal analgesia with lidocaine. A 41 year old female with a cervical polyp was scheduled for total abodminal hysterectomy under epidural analgesia. A lumbar tapping for epidural anaIgesia was performed in a sitting position at a level between L(4~5), using a 18 guage Tuohy needle. Using the "Loss of Resistance" technique to identify the epidural space the first attempt failed. The second attempt was successful at a level of L(3~4) with the same technique. Erroneously the epidural space was identified.
However fluid was dripping very slowly through the needle, which we thought was the fluid from the normal ealine which was injected from outside to identify the space. Then 25ml of 2% lidocaine was administered into the epidural space.
Shortly after the injection of lidocaine, all signs of a high spinal block were observed, accompanied by the following progressing signs of intracranial nerve paralysis: phrenic nerve, vagus nerve, glossopharyngoal nerve and trigeminal nerve in that order. She was then intubated and her respiration was eontrolled without delay. The scheduled operation was carried out uneventfully for 2 hours and 20 minutes. The patient recovered gradually in the reverse order two and half hours from the time after the epidural injection of lidocaine without any permanent damage noted. |
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