title: AANA journal course: update for nurse anesthetists-improving the safety of subarachnoid and epidural blocks--Part A.
abstract: Hypotension caused by reduced venous return to the heart is a common hazard during subarachnoid and epidural anesthesia. Reduced venous return can also cause severe bradycardia and even cardiac arrest. The infusion of a crystalloid intravenous preload prior to the injection of local anesthetic helps prevent these complications. Unfortunately, intravenous fluid preloading prior to subarachnoid or epidural block is neither appropriate for all patients nor is it always effective. Vasopressor infusions and lower extremity compression, though not completely studied, may allow for further decreases in the incidence of hypotension and bradycardia. When dosing an epidural catheter, making each dose a test dose and observing for signs of subarachnoid or intravascular injection decreases the incidence of hypotension, seizure, and cardiotoxicity. The pathophysiology of cardiac arrest and resuscitation is different during major conduction block due primarily to changes in peripheral vascular tone and venous return to the heart. Neural injury associated with regional anesthesia is due to needle trauma, hematoma, injectate toxicity, ischemia, and compression. Though neural injury is rare, it is more commonly associated with blocks performed in the lumbar region (spinals and epidurals) than in other types of blocks.
authors.affiliation: Nurse Anesthesia Program, School of Health Related Professions, University of Alabama at Birmingham, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Fiedler
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000451:nursing* / Q000592:standards*; D004509:Education, Nursing, Continuing; D006801:Humans; D009719:Nurse Anesthetists / Q000193:education / Q000592:standards; D013346:Subarachnoid Space