Transient Coma Due To Epidural Anesthesia: The Role of Loss of Sensory Input

Patient: Female, 22 Final Diagnosis: Coma due to loss of sensory input Symptoms: Coma Medication: Lidocaine Clinical Procedure: Epidural Specialty: Anesthesiology OBJECTIVE: Unknown ethiology BACKGROUND: Epidural anesthesia is the most commonly used method of pain relief during labor in the USA. It is not classically associated with alterations in level of alertness. Coma during the procedure is rare, with a reported incidence of 0.1–0.3%. CASE REPORT: An otherwise healthy patient experienced almost complete loss of brainstem function following routine epidural anesthesia during delivery. The episode lasted for less than 3 hours and the patient made a full recovery. To our knowledge, this is the most detailed clinical observation to date of this condition. CONCLUSIONS: Clinicians should be aware of this rare and potentially serious complication of epidural anesthesia. The case highlights the need for sensory input to maintain alertness through the activity of the ascending reticular activating system.