Hey gents, so I had a bizarre reaction during one of my cases the other day. Called a few people back at the program and nobody had ever heard of anything like this before.
G1P0 presents for scheduled primary CS 2/2 CPD. No PMH, no issues with pregnancy. Perform CSE, small 81kg about 5'6 tall, procedure goes without any issues don't even have to redirect tuohy. Gertie marx needle goes through perfectly, CSF comes back, give 11.25mg 0.75% hyperbaric bupivicaine with 10mcg of fentanyl. Thread catheter, no heme/CSF ect ect.
After taping catheter in place, I notice she has more motor than i am typically accustomed to. I check levels, nothing other than "her feet feeling tingly". I then give 5 cc 2% lidocaine through the epidural catheter. Shortly thereafter patient begins complaining of terrible HA, begins vomiting, and blood pressure is 250/120. I then notice her HR slowly begins to drop from 100's to 80's to 60's to 40's than goes asystolic from what I'm assuming was a vagal/baroreceptor reflex from the elevated BP. Patient begins convulsing from lack of cerebral blood flow. About 5-10 seconds later patient regains consciousness, is A&O x 3, but still complaining of severe HA. We check FHT's which are then depressed so we go to sleep for crash CS. Before going to sleep I checked repeatedly for adequate hand strength which was intact/strong, even though I knew high spinal was unlikely. I even rechecked catheter for CSF/heme throughout the case, nothing.
Baby is delivered, APGAR 8 and 9. I wake mom up and she complains of absolutely NOTHING, no N/V, not even a mild HA. She has T4 levels and is perfectly comfortable in PACU. I get a stat non contrast CTH, everything is normal. Check patient again next day, absolutely nothing wrong.
Anyone have a similar case?
