Background and Aims Cesarean section is commonly performed under spinal anesthesia, as it is simple, rapid, safe, effective, and maintains maternal awareness. Total spinal anesthesia is a known complication manifested by loss of consciousness, severe bradycardia, hypotension, and respiratory arrest. We describe a case of an unconscious event following spinal anesthesia in the presence of stable hemodynamic and respiratory function.
Methods 21-year-old parturient, 150 cm, 60 kg, 40–41 weeks of gestation, primigravida, and premature rupture of membrane, scheduled for cesarean section. The patient was assessed with physical status ASA 2 (pregnancy), without any other medical illness. Spinal anesthesia was performed uneventfully, using a 27G spinal needle, at L3/L4 interspinous space, paramedian approach, with the patient in the left lateral decubitus position. Bupivacaine 0.5% heavy 12.5 mg was administered after cerebrospinal fluid flow was confirmed.
Results When obstetrician would make an incision, approximately 5 minutes following spinal anesthesia, the patient was unresponsive, and her pupil dilated. Hemodynamic status was stable, and no respiratory depression was observed. There were no complaints before the loss of consciousness. Supportive management was done, and the patient regained consciousness one and a half-hour after spinal anesthesia. The rostral spread of inadvertent injection of local anesthetics into subdural space is speculated.
Conclusions Loss of consciousness following spinal anesthesia in non-sedated patients with stable hemodynamic and respiratory function is uncommon, but it should be considered, and resuscitation equipment must always be available. When recognized, supportive treatment, especially airway management, is needed until patient regains consciousness, in accordance with the local anesthetic duration of action.
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