The High Spinal Block Explained
Sep 26, 2023
“I can’t breathe and I can’t feel my hands!” 😱
What is happening?
The “high spinal” is defined as a spinal or epidural that spreads higher than T4 (which is the dermatome at the level of the nipples).
There is usually a reason (large dose, pre-existing epidural, second attempt at spinal), however, it can happen with normal doses when you are least expecting it. For that reason, you need to be ready to recognise and manage a high spinal. ⚡️
What does it look like?
Cardiovascular -> Respiratory -> Neurological
Stage 1️⃣ (T1-T4): low blood pressure and bradycardia
Stage 2️⃣ (C6-C8): numb hands, shortness of breath
Stage 3️⃣ (C3-5): shoulder weakness, respiratory failure
Stage 4️⃣ (Intracranial spread): sedation or loss of consciousness
How do you manage it? 👷🏻♀️
👉🏽 Call for help if required
👉🏽 Stop any further epidural infusion
👉🏽 Ensure left lateral tilt and monitor fetal heart rate
👉🏽 Use an ABCD approach:
———> Secure the airway with rapid sequence induction* (Stage 3 & 4)
———> Support the BP and HR with IV fluids, atropine and vasopressors (Stage 1-4)
*See our Concept Series blog on GA Caesar for more information!
Remember, there are 2 patients and a partner to care for! Reassure mother and partner and include the obstetric team in the management process in case urgent delivery is required 💞
Our friends at @nysora.inc have a great article on the high spinal which is available through a social media bio.
Build knowledge ✅
Improve safety ✅
Ref: https://www.nysora.com/anesthesia/high-or-total-spinal-anesthesia/
