26 year old female patient wanted epidural for labor analgesia. She was given 12ml of 0.25% bupivacaine immediately after this she developed hypotension, bradycardia, respiratory difficulty. Which of the following explains condition of the patient.: (A) Vasovagal attack, (B) Systemic toxicity, (C) Total spinal anaesthesia, (D) Drug allergy
Answer is C. Total spinal is one of the dreaded complication of epidural anaesthesia. Accidental puncture of dura, while giving epidural will cause whole volume (10-20ml) of drug to enter subarachnoid space.
This can reach upto cranium producing total spinal block.