Neuraxial Anesthesia Review and Complications

A situation where the anesthetic effect spreads higher than intended, potentially reaching the cranial nerves.

A type of high neural blockade where the anesthetic reaches the cranial nerves, causing unconsciousness, apnea, and hypotension.

A situation where the anesthetic effect is not enough to provide adequate pain relief or paralysis during surgery.

Accidental injection of the anesthetic into a blood vessel, which can lead to very high levels of the drug in the bloodstream.

The failure to achieve adequate anesthesia or analgesia despite obtaining cerebrospinal fluid (CSF) during spinal anesthesia.

The movement of the needle during injection, incomplete needle entry into the subarachnoid space, or loss of potency of the local anesthetic solution.

Factors such as administering an excessive dose, not adjusting doses for factors like age or weight, or unusual sensitivity to the anesthetic. These can lead to excessive spreading of the anesthetic.

Signs and symptoms of high neural blockade, including dyspnea (difficulty breathing), numbness or weakness in the upper extremities, and nausea often preceding hypotension.

High doses of local anesthetics can disrupt the central nervous system, causing seizures and unconsciousness. They also affect the cardiovascular system, leading to low blood pressure, irregular heartbeats, and weakened heart contraction.

Treatment involves addressing airway, breathing, and circulation (ABC) and administering lipid emulsion.

Blockade of nerves supplying the bladder (S2-S4) reduces bladder muscle tone and prevents the urge to urinate, leading to difficulty emptying the bladder. Opioids administered in the epidural space can also contribute to this.

The needle used for neuraxial blocks can cause tissue damage, leading to bruising, inflammation, and muscle spasms, resulting in back pain.

A severe headache that worsens when sitting or standing and improves when lying down, often accompanied by sensitivity to light and nausea. It typically starts within 12-72 hours after the procedure.

Factors that increase the risk of PDPH include larger needles, cutting-point needles, younger age, being female, and pregnancy.

PDPH is often treated conservatively with rest, pain relievers, fluids, and caffeine. In severe cases, blood is injected into the epidural space (epidural blood patch) to seal the leak.

Damage to nerve roots or the spinal cord can occur during neuraxial blocks, leading to neurological complications.

Bleeding into the spinal canal, usually minor and harmless, but can be significant in patients with bleeding disorders or clotting issues. Hematoma compresses neural tissue, causing pain, muscle weakness, and even bowel/bladder dysfunction.

Infection of the spinal meninges (membranes surrounding the brain and spinal cord), usually caused by contaminated equipment or solutions. Causes pain, neurological symptoms. Strict sterile technique is essential.

A rare but serious complication of neuraxial anesthesia, involving an abscess (collection of pus) in the epidural space. Causes back pain, nerve pain, weakness, and fever.

A type of anesthesia that involves injecting medication into the spinal canal, blocking pain signals and providing numbness below the injection site. Often used in surgeries involving the lower body.

A type of anesthesia involving injecting medication near the spinal cord, creating a block of pain sensations. Can be used for labor pain management or surgeries.

The highest point of the spinal cord, usually at the first lumbar vertebra (L1). Neuraxial blocks should be performed below this point to avoid spinal cord injury.

A type of anesthesia that involves injecting medication into the epidural space around the spinal cord. Often used for labor pain management or surgeries.

A blood clot in the epidural space, often asymptomatic but can cause serious neurological complications if it's large. Usually occurs in patients with bleeding disorders or clotting issues.