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High or Total Spinal/Epidural 

High or Total Spinal/Epidural
Chapter:
High or Total Spinal/Epidural
Author(s):

Feyce Peralta

DOI:
10.1093/med/9780190226459.003.0044
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date: 19 February 2020

High or total spinal/epidural blockade occurs due to excess spread of local anesthetic within the neuraxial space. While this is an infrequent complication, it can cause respiratory and hemodynamic instability in obstetric patients. If high/total spinal/epidural occurs prior to delivery, such derangements may lead to fetal intolerance and need for emergency delivery. Clinicians should suspect risk for high block when patients lose upper extremity motor function and complain of dysphonia or dyspnea. Intubation and respiratory and hemodynamic support along with adequate sedation should be given until the block recedes. Preventative measures include strict epidural catheter aspiration practice and incremental epidural dosing strategies.

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