Penetration into the subarachnoid space
Total Spinal Anesthesia
• Total spinal anesthesia results when the level of block is above the cervical region, thus involving the entire spinal cord and occasionally the brainstem during either spinal or epidural anesthesia.
Causes
• Excessive cephalad spread of local anesthetic in subarachnoid space during spinal anesthesia.
• Accidental intrathecal injection during epidural anesthesia as a result of dural puncture.
Clinical Features
• It is manifested as bradycardia, hypotension, dyspnea, difficulty in swallowing & loss of consciousness.
• Respiratory arrest occurs as a result of respiratory muscle paralysis or brainstem involvement.
Management
• Supportive treatment with oxygenation, IV fluids & vasopressors.