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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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2015
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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. |
format | Online Article Text |
id | pubmed-4383124 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
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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