Obstetric case

[anbuitachi]

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Taking it back to med school: anxiety/fight or flight response > intrinsic epi release > activation of a1 receptors on the iris dilators > mydriasis.

med school is important for learning (sometimes)

 

[DocVapor]

Taking it back to med school: anxiety/fight or flight response > intrinsic epi release > activation of a1 receptors on the iris dilators > mydriasis.

Off topic, but does anyone else really ****ing hate the terms miosis and mydriasis? I hate them with the rage of a thousand demons.

 

[repititionition]

Off topic, but does anyone else really ****ing hate the terms miosis and mydriasis? I hate them with the rage of a thousand demons.

the longer word has the wider pupil.

this has gotten me through 8 years of medical education and continues to serve me well.

 

[IlDestriero]

Like ARCH and others have stated there is a paper out addressing this issue. Mainly in young people, with ephedrine being the drug of choice I believe. Later, Zofran came to light in somehow decreasing these events from occurring.

I’ve seen this in residency. I give every cs patient 4mg ondansetron prior to placing the spinal.
Epi is the drug of choice for profound bradycardia/CV collapse after a spinal. +/- chest compressions.

 

[Lecithin5]

Bezold reflex is powerful. Briefly did epi/compressions a month ago from an OB spinal. As to your question- I think your choice of anesthetic can go either way and you can make a good case for either one (ga vs epi vs spinal).

 

[abolt18]

the longer word has the wider pupil.

this has gotten me through 8 years of medical education and continues to serve me well.

Lol I always just had to say my"D"riasis is "D"ilated. It's the only way I can remember.

 

[MirrorTodd]

Lol I always just had to say my"D"riasis is "D"ilated. It's the only way I can remember.

Love the D.

 

[LineAndBerry]

Is a subdural injection a possible explanation here? Agree that signs and time frame not consistent but just wondering.

 

[Gern Blansten]

Is a subdural injection a possible explanation here? Agree that signs and time frame not consistent but just wondering.

I have seen a couple of those before. Typically slow onset over 15-20 minutes, in my experience. Block is typically between an epidural and SAB as far as block density, so I would not think it would behave like a high spinal. It can make an epidural injection seem more like a spinal block, but I would think it would make an intended SAB seem weaker and ineffective.
Subdural blocks are a bit nebulous and kind of like a chupacabra. Everyone knows someone who claims to have seen one, but there is always a bit of mystery around it.

 

[pocafx]

How long does a high spinal take to wear off?

I think i saw a "high spinal" with an epidural once. It was after a wet tap. Was on floor for a bit, then c/s called. After 10-15cc 2% lido bolus patient had high spinal, hypotensive, unresponsive, apneic. began to breathe again shortly after and then did wake up. I dont know exact details about how long to wake up or stop using pressors. ,

 

[Gern Blansten]

How long does a high spinal take to wear off?

I think i saw a "high spinal" with an epidural once. It was after a wet tap. Was on floor for a bit, then c/s called. After 10-15cc 2% lido bolus patient had high spinal, hypotensive, unresponsive, apneic. began to breathe again shortly after and then did wake up. I dont know exact details about how long to wake up or stop using pressors. ,

The couple that I have seen "stop being high spinals" after about 10 minutes. Essentially, it is still a very good spinal that continues to be effective, but is no longer providing brainstem anesthesia after 10-15 minutes, and they start breathing again. Would love to hear from others to see if that is their norm.

 

[Arch Guillotti]

The couple that I have seen "stop being high spinals" after about 10 minutes. Essentially, it is still a very good spinal that continues to be effective, but is no longer providing brainstem anesthesia after 10-15 minutes, and they start breathing again. Would love to hear from others to see if that is their norm.

Same.

 

[hiyaman]

The couple that I have seen "stop being high spinals" after about 10 minutes. Essentially, it is still a very good spinal that continues to be effective, but is no longer providing brainstem anesthesia after 10-15 minutes, and they start breathing again. Would love to hear from others to see if that is their norm.

I've only seen one high spinal in residency and that was how it went as well.

 

[coffeebythelake]

Love the D.

tmi..

 

[narcusprince]

Anyone think Chiari malformation with a spinal? Micro herniation with spinal leakage of csf?