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PAIN MEDICINE

Reversal of an Unintentional Spinal Anesthetic by Cerebrospinal Lavage

Ban C. H. Tsui, MD MSc, FRCP(C)^*, Stephan Malherbe, MB ChB, MMed, FCA(SA)^*, John Koller, MD FRCP(C)^*, and Keith Aronyk, MD FRCS(C)

Departments of *Anesthesiology and Pain Medicine and Neurosurgery, University of Alberta, Edmonton, Alberta, Canada

Address correspondence and reprint requests to Ban C. H. Tsui, MD, MSc, FRCP(C), Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, 3B2.32 Walter Mackenzie Health Science Centre, 8440-112 St., Edmonton, Alberta, Canada T6G 2B7. Address e-mail to btsui{at}ualberta.ca

In this case report, we describe the use of cerebrospinal fluid lavage as a successful treatment of an inadvertent intrathecally placed epidural catheter in a 14-yr-old girl who underwent a combination of epidural anesthesia and general anesthesia for orthopedic surgery. In this case, a large amount of local anesthetic was injected (the total possible intrathecal injection was 200 mg of lidocaine and 61 mg of bupivacaine), resulting in apnea and fixed dilated pupils in the patient at the end of surgery. Twenty milliliters of cerebrospinal fluid was replaced with 10 mL of normal saline and 10 mL of lactated Ringer’s solution from the "epidural" catheter. Spontaneous respiration returned 5 min later, and the patient was tracheally extubated after 30 min. No signs of neurological deficit or postdural puncture headache were noted after surgery.

IMPLICATIONS: Cerebrospinal lavage may be a helpful adjunct to the conventional supportive management of patients in the event of an inadvertent total spinal.

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