Epidural anesthesia complications

This is a video on complications of epidural anesthesia. This video was made using Google Slides. Graphics were created or adapted from Wikimedia Commons. ADDITIONAL TAGS: Disease: Pathophys: Signs / symptoms: Treatment / management: Local anesthetic systemic toxicity Catheter goes into epidural vasculature (systemic circulation) → CNS overactivity Perioral numbness, metallic taste, tinnitus, seizures; tachycardia, hypertension Stop the drug! Benzodiazepine for seizure control; supportive care Epidural- associated hypotension Epidural blocks sympathetic nerve (sympathetic blockage) → vasodilation, venous pooling → hypotension, tachycardia Systemic hypotension (lightheadedness), compensatory tachycardia If pregnant, left uterine placement (lay on left side); vasopressors (phenylephrine, ephedrine) Inadvertent spinal block; "high spinal"; total spinal anesthesia Local anesthesia pictures dura → ascends upwards in subarachnoid space → depression of cervical spinal cord and brainstem activity Hypotension, bradycardia, complete motor blockage below lower thoracic spinal levels (diaphragm paralysis); dyspnea/apnea; hypoxemia; difficulty swallowing/speaking -Stop the epidural infusion immediately -Supportive: vasopressors, intubation -Positioning: reverse Trendelenburg to decrease ascending anesthetic Postdural puncture headache Unintentional dural puncture during placement of neuraxial anesthesia → headache within 72 hours of procedure Positional headache (worse when upright, improves when supine); stiff neck; n/v photophobia; diplopia; hearing loss/tinnitus Supportive; +/- epidural blood patch Epidural complications spinal cord pia mater arachnoid mater subarachnoid space dura mater epidural space vertebral bones interspinous ligaments ligamentum flavum