Total Spinal

Question 1

What are the signs and symptoms of total spinal anaesthesia?

Answer 1

CVS - Hypotension (N&V), bradycardia, cardiac arrest

Resp - Dyspnoea, breathing difficulty, hypoventilation, hypoxaemia, respiratory arrest

CNS - tingling in hands, difficulty speaking, seizures, loss of consciousness

May be abrupt, or gradual in context of ascending block

Question 2

What are the differential diagnoses?

Answer 2

1. Vasovagal
2. Haemorrhage
3. LA toxicity
4. IVC compression
5. Embolus

Question 3

Outline a management plan for a total spinal

Answer 3

1. Call for help!
2. Start CPR if loss of cardiac output
3. Place in (L) lateral tilt
4. Secure airway, ventilate with 100% O2 if dec LOC or respiratory distress
5. Vasopressors and fluids to maintain adequate blood pressure (Ephedrine, Phenylephrine etc)
6. Elevate legs to improve venous return
7. Adrenaline boluses if limited response to above
8. Atropine for bradycardia
9. Urgent O&G assessment to determine fetal distress necessitating urgent delivery

Question 4

What doses would you give of the following drugs - atropine, ephedrine, phenylephrine, adrenaline

Answer 4

Atropine 0.6-1.2mg

Ephedrine 12-15mg

Phenylephrine 100mcg

Adrenaline 25-50mcg

Question 5

What considerations need to be taken into account when performing CPR?

Answer 5

The gravid uterus needs to be displaced off the IVC - (L) lateral tilt

There is a very high risk of aspiration - consider early intubation

Diminished maternal cardiac output will be exacerbated by a foetus - baby delivery

Question 6

Outline subsequent management if there is no foetal distress

Answer 6

Transfer to ICU for ongoing ventilatory, cardiovascular, and monitoring support

BIS monitoring may be useful to titrate sedation

Document

Exclude other causes of collapse - hypoglycaemia, anaphylaxis, LA toxicity