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LETTER TO THE EDITOR

Cerebrospinal Lavage Seems to Be Safe and Effective in the Reversal of Inadvertent Spinal Anesthetic Injection

Parish Anesthesia Associates; New Orleans, LA; henryliu66{at}yahoo.com

To the Editor:

I read with interest Dr. Tsui's article (1) regarding the use of cerebrospinal lavage to reverse the inadvertent spinal anesthetic injection. I had a similar case in 2001 with a 26-year-old parturient who was in active labor. A lumber epidural catheter was placed without technical difficulty, with negative aspiration and test dose response. After initial loading dose of 0.25% bupivacaine 9 mL (incremental dosing of 3 mL times three), the patient did not develop a spinal block. The sensory blockade level (SBL) was T8 bilaterally, and the 0.2% Naropin infusion started at the rate of 14 mL/h. About 45 min later, the patient developed hypotension and weakness in both upper extremities. Physical examination revealed SBL at C6 bilaterally. Aspiration of the "epidural" catheter obtained free flow CSF. The "epidural" catheter is believed to be intrathecal. Patient remained conscious and spontaneously breathing. To prevent further increase of SBL and impending paralysis of the diaphragm, we decided to perform cerebrospinal lavage by aspirating CSF 20 mL slowly and replacing with normal saline (preservative free) 20 mL. The process was repeated once, and we closely monitored the SBL changes. About 30 min later, SBL was C7-T1. Another 30 min later, the patient developed late decelerations. Immediate cesarean section was performed with no additional local anesthetic given. SBL was T2 just before incision. The motor function recovered about 75 min after the 45-min cesarean section. The patient was discharged the next day, and the follow-up examination did not find any complications. Dr. Malinow of the University of Maryland mentioned a similar obstetric case and that patient also did well. Cerebrospinal lavage seems to be safe and effective if performed appropriately.

Reference

1. Tsui BC, Malherbe S, Koller J, Aronyk K. Reversal of an unintentional spinal anesthetic by cerebrospinal lavage. Anesth Analg 2004;98:434–6.[Abstract/Free Full Text]

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