title: [A case of total spinal block during epidural anaesthesia].
abstract: Most cases of total spinal block have been reported in the literature. The displacement of the catheter and the consequent dural perforation are the causes in large percentage of the patients (75%). The Authors describe this case for the importance of the causes and outcome of the patient. A 48 years old woman presented for hysterectomy for uterine fibromas. After having individualized the L3-L4 interspace, a test dose of 3 ml carbocaine 2% was injected. After that, the spinal block was obtained using ropivacaine 0.75% (total dose = 10 ml) injecting slowly, in following times, 5+5 ml of anaesthetic solution. The patient, perfectly conscious at first, presented a gradual increase of the difficulty in talking and breathing. Subsequently she showed a complete paralysis with loss of the consciousness, respiratory arrest, bilateral and symmetrical midriasis, as well as total areflexia. Endotracheal tube was placed. After eighty minutes from the end of the administration of the local anesthetic, spontaneous thoracic excursions appeared, even though of moderate ampleness, midriasis reduced. The patient recovered consciousness and sufficiently ventilated; therefore the endotracheal tube was removed.
authors.affiliation: Università degli Studi La Sapienza di Roma, Dipartimento di Chirurgia P. Valdoni.
authors.forename: S
authors.initials: S
authors.lastname: Gazzanelli
authors.forename: F
authors.initials: F
authors.lastname: Pierannunzi
authors.forename: A
authors.initials: A
authors.lastname: Vari
authors.forename: F
authors.initials: F
authors.lastname: Caccamo
authors.forename: S
authors.initials: S
authors.lastname: Riccardi
authors.forename: A
authors.initials: A
authors.lastname: Fermariello
authors.forename: S
authors.initials: S
authors.lastname: Tarquini
authors.forename: A
authors.initials: A
authors.lastname: Casullo
authors.forename: M
authors.initials: M
authors.lastname: Caputo
authors.forename: U
authors.initials: U
authors.lastname: Costi
authors.forename: H
authors.initials: H
authors.lastname: Al Radhi
authors.forename: Z
authors.initials: Z
authors.lastname: Kharrub
authors.forename: L
authors.initials: L
authors.lastname: Izzo
mesh_terms: D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007278:Injections, Spinal; D007442:Intubation, Intratracheal; D008619:Mepivacaine / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D010243:Paralysis / Q000139:chemically induced / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000209:etiology* / Q000628:therapy; D000077212:Ropivacaine; D013116:Spinal Cord / Q000187:drug effects*; D014474:Unconsciousness / Q000139:chemically induced / Q000209:etiology*
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008619:Mepivacaine