Total Spinal Anesthesia Following an Interscalene Block Treated with Intravenous Lipid Emulsion

Abstract

Total spinal anesthesia following interscalene block is a rare and life-threatening complication of regional anesthesia. A 56-year-old woman underwent an uncomplicated left shoulder bone spur removal under general anesthesia with an interscalene nerve block at an outpatient surgical center. Subsequently, she developed bilateral mydriasis, paralysis of all extremities, and respiratory arrest. She was intubated and transferred to the emergency department (ED) where she was given intravenous lipid emulsion (ILE) with complete recovery of neurological function. ILE therapy may be considered as a rescue treatment in addition to supportive therapy for total spinal anesthesia.

Suspected local anaesthetic systemic toxicity (LAST) after several bupivacaine injections through an epidural catheter in a cat

“…Total spinal anaesthesia occurs when the local anaesthetic is accidentally deposited in the spinal canal instead of the epidural space. 20 The rapid migration of the drug into the brainstem can lead into a sudden neurological and cardiovascular deterioration and ultimately cardiorespiratory arrest. 19,20 These signs are too acute to be the cause of the ocular changes.…”

“…20 The rapid migration of the drug into the brainstem can lead into a sudden neurological and cardiovascular deterioration and ultimately cardiorespiratory arrest. 19,20 These signs are too acute to be the cause of the ocular changes.…”

A case of total spinal anesthesia

“…From the literature review, total spinal anesthesia can happen during epidural anesthesia, caudal anesthesia, spinal anesthesia, paravertebral block, stellate ganglion block, interscalene brachial blocks, and other regional anesthesia techniques performed at or near to the vertebral column. The clinical manifestations are often characterized by a sudden decrease in blood pressure, rapidly increasing motor block, temporary loss of breathing, loss of consciousness, dilated pupils, apnea, and even cardiac arrest [ [8] , [9] , [10] , [11] , [12] ].…”

Manejo analgésico postoperatorio con bloqueos regionales guiados por ultrasonografía en cirugía de hombro

“…Con el uso del USG la aguja se inserta aplicando una técnica en plano (alineación con el eje largo de la sonda) o una técnica fuera de plano (alienación con el eje corto de la sonda), la primera permite mejor visualización de la aguja, mientras que la segunda proporciona una trayectoria más corta hacia el objetivo (Figura 3). Existen múltiples complicaciones reportadas entre las que destacan: bloqueo del nervio frénico que resulta en parálisis hemidiafragmática, 16 síndrome de Horner, 17 bloqueo del nervio laríngeo, 18 bloqueo epidural alto 19 o espinal total, 20 neumotórax, 21 inyección intravascular, 22 daño nervioso directo, 23 toxicidad por anestésico local, 24 mismas que han disminuido de manera considerable como consecuencia de la incorporación del USG. 25 Figura 2: Identificación por ultrasonido del plexo braquial entre los músculos escaleno medio y escaleno anterior por debajo del músculo esternocleidomastoideo.…”