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Discussion

Spinal gone bad

I am curious about something..... Last week a patient was transferred to my unit from the OR. She was scheduled for a tka but when the anesthesiologist did her spinal, it went up instead of down. What I was wondering is.. what can cause this to happen and how often does it occur? Luckily she was t/v quickly and we extubated her once the spinal wore off. I was unable to speak with the anesthesiologist myself because we were crazy busy and I was charge that night so no time for chit chat. Thanks!!!!

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Without knowing specifics, here are a couple of reasons.

Physiologic narrowing of the spinal canal, causing an upward spread of anesthetic.

Patient positioning post injection causing cephalad spread of anesthetic.

Too large a volume of anesthetic injected, again causing cephalad spread.

Hypobaric solution rising.

Any one of these, and possibly many more.

I am glad to hear that the outcome was without lasting problems for the patient.

There are also rare cases in which the spinal needle is not advanced far enough and only the tip of the needle is in the Subarachnoid space. In such a case, some drug is also injected in the subdural space and it only takes a miniscule amount of drug in the subdural space to travel all the way up. This happens almost exclusively with beveled needles.

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