Spinal gone bad

[ccusherry]

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!!!!

[nilepoc]

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.

[sandman1]

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.