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Inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline

Here we present a case of high spinal blockade in a patient belonging to ASA Grade I which lead to need for endotracheal intubation. A 35 year old healthy male, weighing 59 kg, of height 165 cms presented with a post traumatic raw area over the left lower limb. A reverse sural graft along with skin...

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Autores principales: Dhir, Vinod Bala, Sharma, Anupama Gill, Kaur, Mohandeep, Gulabani, Michell
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383124/
https://www.ncbi.nlm.nih.gov/pubmed/25886433
http://dx.doi.org/10.4103/0259-1162.150165
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author Dhir, Vinod Bala
Sharma, Anupama Gill
Kaur, Mohandeep
Gulabani, Michell
author_facet Dhir, Vinod Bala
Sharma, Anupama Gill
Kaur, Mohandeep
Gulabani, Michell
author_sort Dhir, Vinod Bala
collection PubMed
description Here we present a case of high spinal blockade in a patient belonging to ASA Grade I which lead to need for endotracheal intubation. A 35 year old healthy male, weighing 59 kg, of height 165 cms presented with a post traumatic raw area over the left lower limb. A reverse sural graft along with skin grafting (from the thigh) was planned. In OR, the patient was placed in sitting position and the extradural space was identified by ‘loss of resistance to air’ technique at the L2-L3 intervertebral space. The catheter could not be threaded into the extradural space, hence 5ml of 0.9% saline was injected. However, still the catheter could not be negotiated. Further attempts to identify the extradural space at the L1-L2 and L3-L4 interspace levels were made. During these attempts a total of 18 ml of 0.9% saline was injected into the extradural space. Within 2 minutes blood pressure fell to 90/60 mmHg. Injection mephenteramine (3 mg) was given intravenously and a slight head up tilt was applied. After 2 more minutes the patient started complaining of tingling in his hands and difficulty in breathing. Oxygen 100% was administered via a face mask attached to the anesthesia circle system. In view of onset of respiratory failure, general anesthesia was induced. Thiopentone (200 mg) and Suxamethonium (75 mg) were given intravenously, the patient's trachea was intubated and his lungs ventilated with 40% oxygen, 60% nitrous oxide and 0.2-0.4% Isoflurane, without additional neuromuscular blockade. The arterial saturation promptly returned to 97% and, immediately after intubation, the heart rate was found to be 103 beats/min and the arterial BP 162/102 mmHg. At the end of surgery, spontaneous ventilation returned and the patient was allowed to breathe 100% oxygen via the tracheal tube until he awoke, when his trachea was extubated.
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spelling pubmed-43831242015-04-13 Inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline Dhir, Vinod Bala Sharma, Anupama Gill Kaur, Mohandeep Gulabani, Michell Anesth Essays Res Case Report Here we present a case of high spinal blockade in a patient belonging to ASA Grade I which lead to need for endotracheal intubation. A 35 year old healthy male, weighing 59 kg, of height 165 cms presented with a post traumatic raw area over the left lower limb. A reverse sural graft along with skin grafting (from the thigh) was planned. In OR, the patient was placed in sitting position and the extradural space was identified by ‘loss of resistance to air’ technique at the L2-L3 intervertebral space. The catheter could not be threaded into the extradural space, hence 5ml of 0.9% saline was injected. However, still the catheter could not be negotiated. Further attempts to identify the extradural space at the L1-L2 and L3-L4 interspace levels were made. During these attempts a total of 18 ml of 0.9% saline was injected into the extradural space. Within 2 minutes blood pressure fell to 90/60 mmHg. Injection mephenteramine (3 mg) was given intravenously and a slight head up tilt was applied. After 2 more minutes the patient started complaining of tingling in his hands and difficulty in breathing. Oxygen 100% was administered via a face mask attached to the anesthesia circle system. In view of onset of respiratory failure, general anesthesia was induced. Thiopentone (200 mg) and Suxamethonium (75 mg) were given intravenously, the patient's trachea was intubated and his lungs ventilated with 40% oxygen, 60% nitrous oxide and 0.2-0.4% Isoflurane, without additional neuromuscular blockade. The arterial saturation promptly returned to 97% and, immediately after intubation, the heart rate was found to be 103 beats/min and the arterial BP 162/102 mmHg. At the end of surgery, spontaneous ventilation returned and the patient was allowed to breathe 100% oxygen via the tracheal tube until he awoke, when his trachea was extubated. Medknow Publications & Media Pvt Ltd 2015 /pmc/articles/PMC4383124/ /pubmed/25886433 http://dx.doi.org/10.4103/0259-1162.150165 Text en Copyright: © Anesthesia: Essays and Researches http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Dhir, Vinod Bala
Sharma, Anupama Gill
Kaur, Mohandeep
Gulabani, Michell
Inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline
title Inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline
title_full Inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline
title_fullStr Inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline
title_full_unstemmed Inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline
title_short Inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline
title_sort inadvertent high spinal anesthesia as sequelae to epidural injection of normal saline
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383124/
https://www.ncbi.nlm.nih.gov/pubmed/25886433
http://dx.doi.org/10.4103/0259-1162.150165
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