///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

High and Total - Spinal Anesthesia: A Systematic Review

Abstract Number: T2D-393
Abstract Type: Original Research

Unyime Ituk MBBS, FCARCSI1 ; Erik W Anderson MA2; Michael Heffernan BS3; Unyime Ituk MBBS4; Cynthia Wong MD5

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

SOAP 2019