Conventional precautions do not preclude accidental total spinal anaesthesia during epidural analgesia for labour, necessitating the ready availability of resuscitation equipment and personnel.
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May indicate conventional precautions insufficient to prevent total spinal in labour epidurals; single case leaves open incidence and prevention questions.
A 26-year-old woman sustained accidental total spinal block following induction of epidural analgesia for labour, despite conventional precautions for prevention of this complication. Unusual features included slow onset of block, only slight hypotension, the need for a muscle relaxant drug to assist with intubation, and only a brief period of unconsciousness. Possible mechanisms include massive subarachnoid block, subdural block, and massive epidural block. This case demonstrates that conventional precautions do not preclude accidental total spinal anaesthesia, and that drugs, equipment, and an anaesthetist must be readily available in all areas where epidural analgesia is in progress.
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Skowronski et al. (1981) studied this question.
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