Delayed respiratory arrest in combined spinal-epidural anesthesia. Case report.
OBJECTIVE
A case of delayed respiratory arrest in the combined spinal-epidural anesthesia (CSEA) is described. This event was likely due to morphine injected through the epidural catheter, unintentionally entering into the subarachnoid space through the hole in the dura that was made previously by the spinal needle in the needle-through-needle technique.


METHODS
The CSEA is a popular new regional anesthesia that combines the benefits of the spinal and epidural injections. The needle-through-needle technique, which is only one of the various techniques to accomplish CSEA, may increase the risk of unintentionally allowing the entry of the epidural catheter into the subarachnoid space because the spinal needle and epidural catheter have the same pathway.


RESULTS
This is the second case report of this event with the needle-through-needle technique. The FDA has recently approved this needle-through-needle technique.


CONCLUSIONS
Careful attention to technique is necessary with utilization of CSEA.
Department of Anesthesia, Misgav Ladach General Hospital, Jerusalem, Israel.
J
J
Eldor
P
P
Guedj
S
S
Levine
D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D001049:Apnea / Q000139:chemically induced*; D002045:Bupivacaine / Q000008:administration & dosage; D004388:Dura Mater / Q000293:injuries; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D009339:Needles / Q000009:adverse effects; D011677:Punctures / Q000009:adverse effects / Q000295:instrumentation; D013346:Subarachnoid Space
D009020:Morphine; D002045:Bupivacaine