[Cardiorespiratory arrest: a rare complication of subdural block].
We report a case of accidental subdural block after epidural anesthesia that manifested as cardiac arrest due to extensive spinal blockade 20 minutes after administration of 50 mg of 0.5% bupivacaine. The event resolved without sequelae. Subdural placement of the catheter was verified by computed axial tomography contrast medium. Clinical signs of subdural block are highly variable, extensive neural block being among the possible rare presentations, with latency ranging from a few minutes to as long as 30. Recent electron microscope observations with new methods for fixing and preparing tissues suggest that the dubdural space does not exist naturally, but rather forms artificially within a low-resistance cell plane composed of neurothelial cells, as a result of trauma or the injection of a local anesthetic. The characteristics of the space depend, therefore, on factors that come together at the site. These data explain the great variability in the clinical manifestations of a subdural block. The case of cardiopulmonary arrest we report is rare in the literature.
Silva Costa-Gomes
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Servicio de Anestesiología y Reanimación Hospital Universitario del Mar Paseo Marítimo, 25-29 08003 Barcelona.
Montes
A
A
Sánchez
J C
JC
Bermejo
S
S
Escolano
F
F
D000368:Aged; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001049:Apnea / Q000139:chemically induced* / Q000503:physiopathology; D019644:Arthroplasty, Replacement, Hip; D001919:Bradycardia / Q000139:chemically induced; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation; D002404:Catheterization; D004388:Dura Mater / Q000293:injuries*; D006323:Heart Arrest / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007431:Intraoperative Complications / Q000139:chemically induced*; D008297:Male; D013355:Subdural Space; D014057:Tomography, X-Ray Computed
D000779:Anesthetics, Local; D002045:Bupivacaine