High Central Neuraxial Block - Guidelines for Crises in Anaesthesia • Can occur with deliberate or accidental injection of local anaesthetic drugs into the subarachnoid space. • Symptoms are – in sequence – hypotension and bradycardia – difficulty breathing – paralysis of the arms – impaired consciousness – apnoea and unconsciousness. • Progression through this sequence can be slow or fast. ❶ Reassure the patient – remember that they may be fully aware. • Plan to ensure hypnosis as soon as clinical situation permits. ❷ Call for help and inform theatre team of the problem. ❸ Treat airway and breathing: • Give 100% oxygen. • Chin lift / jaw thrust may suffice. • Consider supraglottic airway or tracheal intubation (Box A). ❹ Treat circulatory insufficiency: • Give i.v. fluid by rapid infusion. • Elevate the legs. Do not use head-down tilt. • In obstetrics, relieve aorto-caval compression. • Bradycardia: give atropine or glycopyrrolate (Box B). • Hypotension: give metaraminol, phenylephrine or ephedrine (Box B). • CPR may be necessary to circulate drugs. ❺ If the case is obstetric, consider expedited delivery of the baby to manage: • Risk to mother of unrelieved aorto-caval compression • Risk to fetus of impaired feto-placental oxygen delivery ❻ Consider other causes that may mimic signs and symptoms, including (Box C): • Obstetric aorto-caval compression. • Local anaesthetic toxicity. • Embolism. • Vasovagal event. • Haemorrhage. ❼ Plan ongoing care in a suitable location. By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #High #Central #Neuraxial #Block #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
