Total spinal anesthesia following brachial plexus block

Abstract

Shortly after a perivascular brachial plexus block was performed via the interscalene approach, the patient lost consciousness and stopped breathing. The blood pressure dropped to 80/60 torr. The patient's body became generally flaccid. Ventilation by mask with pure oxygen was begun, the trachea was intubated, and ventilation was manually assisted. The foot of the stretcher was elevated and ephedrine, 10 mg, was administered i.v. The blood pressure was then noted to be 100/65 torr, at which level it remained until resuscitation was completed. The pupils became maximally dilated and unreactive to light, and no corneal reflex could be elicited. The pulse was normal, and electrocardiographic monitoring showed normal sinus rhythm, with a rate of 80/min. Diazepam, 10 mg, and scopolamine, 0.43 mg, were given i.v. to ensure amnesia. Manual assistance of ventilation was continued for 2 hr, after which time the patient opened his eyes and immediately began to move all 4 extremities. Spontaneous ventilation was found to be adequate. The endotracheal tube was left in place for an additional 15 min to insure an adequate and protected airway. Following extubation the patient was monitored in the recovery room for an additional 3 hr. Repeated neurologic examinations demonstrated no abnormality. The patient was conscious and oriented but had no recall of the events from the time the block was begun. The case is discussed.