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Delayed Respiratory Arrest in Combined Spinal-Epidural Anesthesia: Case Report
  1. Joseph Eldor, M.D.,
  2. Pierre Guedj, M.D. and
  3. Shmuel Levine, M.D.
  1. From the Department of Anesthesia, Misgav Ladach General Hospital, Jerusalem, Israel
  1. Reprint requests: Joseph Eldor, M.D., Department of Anesthesia, Misgav Ladach General Hospital, P.O.B. 12142, Jerusalem 91120, Israel.


Background and Objectives A case of delayed respiratory arrest in the combined spinalepidural 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.

  • anesthesia
  • spinal
  • combined spinal-epidural
  • morphine-spinal
  • epidural

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