Join now to get access to this content and more.
Become a SOAP member and have access to our benefits.
- 2020 SOAP Virtual Meeting Series Videos
- For Review: SOAP Consensus Statement on Neuraxial Procedures in Thrombocytopenic Parturients
- Sample Centers of Excellence Applications
- ASA Corner
- SOAP Policy and Procedure Manual (P&P Manual)
- SOAP Expert Opinions
- SOAP's Learning Modules
- 2019 Annual Meeting Lecture Videos
- December 2018 - SOAP Unofficial Guide to ASA Committees Webinar
- Submit a Position
- View Job Postings
- Previous Meeting Archives
- Previous Meeting Abstract Search
- CMS Guidelines
- Member Benefits
- Newsletter Clinical Articles
- ACOG Documents
- Search our Patient Safety Archive
- Ask SOAP a Question
- Global Health Opportunities
- And more…
High and Total - Spinal Anesthesia: A Systematic Review
Abstract Number: T2D-393
Abstract Type: Original Research
Introduction: High- or total spinal anesthesia is a rare yet serious complication of neuraxial anesthesia that can be caused by unintentional or unrecognized injection of local anesthetic into the subarachnoid space or unintentional cephalad extension of a neuraxial blockade. A prospective multicenter audit reported an incidence in the obstetric population of 1:4,336 neuraxial procedures.1 Multiple case reports and small series have highlighted this complication, but these individual reports give little information about risk factors, natural history of the event, and best treatment practices. Our aim was to perform a qualitative systematic review to identify all reports, identify commonalities and develop a better understanding of risk factors, the natural history, and best treatment practices.
Methods: This study was conducted according to PRISMA guidelines and the protocol was registered on the PROSPERO website. PubMed, EMBASE, CINAHL, Web of Science, Cochrane and Google Scholar were systematically searched without date restrictions. We manually searched the UK Confidential Enquiries into Maternal Deaths (1970-2017), the abstracts from annual meetings of the Society for Obstetric Anesthesia and Perinatology (2009-2018) and the American Society of Anesthesiology (2000-2018). Data extracted from each report included patient demographics, primary procedure, type and level of neuraxial anesthesia, drugs and doses, first sign or symptom, time of first sign or symptom, intervention, time until resolution, and observed complications.
Results: The search identified 8,052 sources. After de-duplication and eligibility screening, 91 sources and 127 cases were eligible for inclusion. Patient demographics, primary procedure, neuraxial anesthesia used, and patient outcomes are reported in the Table. Nine patients died (5 immediately and 4 within one week) and 2 had permanent injury).
Discussion: Most patients who experienced high or total spinal anesthesia had perioperative complications but were discharged without permanent sequelae. Most patients had rapid onset of initial signs, but 27 patients presented with symptoms more than 30 minutes after the injection of anesthetic. A high index of suspicion and high-quality resuscitation are necessary to good outcomes.
1. D'Angelo R, et al.. Anesthesiology 2014 Jun;120:1505-12