Pregnant women complicated with high neuraxial block after receiving epidural anesthesia during labor

https://sci-hub.yncjkj.com/10.1016/s0959-289x(98)80021-6
Complications of obstetric epidural analgesia and anesthesia: prospective analysis of 10995 cases
This study done in 1998 highlights the minor and major complications of epidural anesthesia. Data was collected postpartum from a patient review as well as medical records detailing the procedure between July 1989 and August 1994. Hypotension was defined as a fall in the systolic blood pressure greater than 30%. Focusing on the main complication related to our study which is unexpected high block, there were 8 cases in total (1 in 1400), 2 requiring intubation after developing symptoms of dyspnea. Some cases of neurological complications were due to incorrect placememt of the catheter puncturing the dura.
https://link.springer.com/article/10.1007/s12630-016-0701-3#Bib1
Evalution of failed and high blocks associated with spinal anesthesia for Cesarean delivery following inadequate labour epidural: a retrospective cohort
This study done in 2016 investigated factors associated with failed and high spinal blocks in patients who received spinal anesthesia for caesarean following inadequate epidural. Of the 263 patients, there was 9 high spinal blocks reported. High spinal was defined as the need to convert to general anesthesia within first 20 minutes due to weakness, altered mentation, respiratory distress, or a recorded block heigh >T1 dermatome. Of the 9 patients, 3 had epidural sensory block level recorded prior to spinal (T10 and T9).
https://journals.sagepub.com/doi/epdf/10.1177/0310057X8100900312
Total spinal block complicating epidural analgesia in labour: case report
This case report details the incident of an accidental total spinal block following induction of epidural in a 26-year-old woman despite all precautions presenting with unusual features. This consisted of only slight hypotension, brief unconsciousness and the need for muscle relaxant to mediate intubation. After administering the ful dose, the patient complained of dysnpea which was accompanied with anxiety and worsened over the course of 15 minutes with diminished chest movement and jerky uncoordinated movement with slight cyanosis observed. However blood pressure remained at a stable 100-110/70. When planning to intubate patient lost consciousness and further drop in blood pressure which was corrected with ephedrine. Post-op the patient developed typical spinal headache and was discharged 6 weeks postnatal. This study concludes the possibility of incorrect placement and puncturing the dura resulting in such features rather than it being attributed to the epidural block itself.
https://sci-hub.yncjkj.com/10.1016/j.ijoa.2004.07.009
Some immediate serious complications of obstretric epidural analegesia and anesthesia: a prosprecive study of 145 550 epidurals
This study done in 2005 covered a 17-year period of epidurals (1987 to 2003). Of the complications present high or total spinal block was diagnosed by the presence of rapidly progressing motor and sensory block followed by respiratory paralysis requiring intubation, hypoitention and loss of consciousness. Only 9 cases were reported to have high or total spinal block.
SARAH
https://journals.lww.com/anesthesia-analgesia/fulltext/9900/high_neuraxial_block_in_obstetrics__a_2_5_year.723.aspx
A prospective, population-based cohort study was designed to identify cases of high neuraxial block requiring ventilatory support or cardiopulmonary resuscitation between November 2019 and May 2022. Cases were prospectively collected in all hospitals with a maternity unit. During the study period, 5 cases of high neuraxial block requiring tracheal intubation were identified. Three of 5 identified cases occurred in the operating room after single-shot spinal anaesthesia for Caesarean delivery after epidural analgesia in labour. One case developed in the labour ward due to an inadvertent intrathecal or subdural catheter placed for labour analgesia. The fifth case followed single-shot spinal anaesthesia for elective Caesarean delivery. In conclusion, High neuraxial block could ultimately lead to cardiac arrest, although we identified no such cases. Also, Spinal anaesthesia after epidural analgesia in labour is a common cause of high neuraxial block
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566204/
A case presentation mentioned, This work has been reported in line with the SCARE 2018 criteria.
The proportion of caesarean sections preformed under regional anaesthesia has increased over the last two decades, and this has avoided the problem of difficult airway during anaesthesia. However, despite lower incidences of morbidity and mortality, regional anesthesia can cause troubling to crippling, life-threatening complications. One of the feared complications remained total spinal or complete spinal block
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