5. Hypotension
Most common complication
Due to sympathetic blockade
Treatment:
Prophylactic: preloading with 1-1.5L of
crystalloid
Curative: head low position (15degree)
A. Fluids
B. Ephedrine (vasopressor)
C. Oxygen inhalation
7. Usually because of severe
hypotension leading to
medullary ischemia
OR
Due to high or total spinal
Immediate management:
Intermittent Positive
Pressure Ventilation (IPPV)
Respiratory
Paralysis
(Apnea)
8. Nausea &
vomiting
Due to hypotension causing
central hypoxia
Treatment:
• treat hypotension
• oxygenation
• antiemetics
9. Cardiac arrest
Causes:
• Severe hypotension
• Total spinal/very high spinal
• Local LA toxicity/anaphylaxis
Immediate start CPR
10. High spinal
Or
Total spinal
High spinal: spinal above the
desired level causing
problems to the patient
Too high spinal (above
cervical) is called as very
high or total spinal
Management:
Depend on the level of block
11. Attempt the removal at once
If not possible, get a portable
xray and call for
neurosurgeon
14. Postdural
Spinal
Headache
Low pressure headache due to
seepage of CSF FROM HOLE
CREATED BY SPINAL NEEDLE
Change hemodynamic of CSF
Incidence decrease due to use of
smaller gauge needle
Clinical features:
• Usually presents after 12-24hrs
• Usually occipital but can be
frontal
• May be associated withpain
neck stiffness
• Pain increase on sitting,
relieves on lying down
15. Meningitis
Aseptic: chemical
meningitis because of
antiseptic solution like
betadine, glove's starch,
blood drops transported
with needle
Usually no treatment
required
Infective: usually due to
staph. epidermidis carried
from skin along with needle
Treament: iv antibiotics
16. Due to direct injury to nerve fibers
by trauma or by LA
Usually seen with continuous
spinal with small bore catheters
Clinical features:
• retention of urine
• Incontinence of feces
• Loss of sexual function
• Loss of sesation in periaal
region
Cauda Equina
Syndrome
22. Hypotension
Less seen as compared to
spinal because action of drug
is slow in epidural.
So, body gets time to
compensate
23. Total Spinal
Dura is accidentally punctured by
needle or catheter during injection
Large volume (usually 10-20ml of
drug is used) of hypobaric
solution (plain bupivacaine and
lignocaine are slightly hypobaric)
is injected in subarachnoid space
Manifestations:
• marked hypotension
• bradycardia
• apnea
• dilated pupils
• unconsciousness
Prevention:
• Always confirm the position of
needle/catheter by giving a test dose
with lignocaine + adenaline
• Never inject a bolus, always give
drug in increments of 3-5ml
Treatment:
• Intubate and IPPV with 100% oxygen
• Vasopressor
• Atropine
24. Dural Puncture
Incidence is 1%
If dura is punctured with epidural
needle, there are 2 options:
1. Give hyperbaric LA through this
needle (convert it to spinal)
2. Remove the needle and give
epidural in higher space
Treatment:
Preventive:
needle (small gauge and dura separating)
Adequate hydration (promote CSF production)
Avoid spinal in ptt with ho headache
Curative:
lie supine in slight trendelenburg position
Analgesics
Iv fluid (promote csf production)