Obstetric case

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Beeftenderloin said:
Taking it back to med school: anxiety/fight or flight response > intrinsic epi release > activation of a1 receptors on the iris dilators > mydriasis.
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Off topic, but does anyone else really ****ing hate the terms miosis and mydriasis? I hate them with the rage of a thousand demons.
 
LivetoTell said:
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.
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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.
 
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).
 
LineAndBerry said:
Is a subdural injection a possible explanation here? Agree that signs and time frame not consistent but just wondering.
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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.
 
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. ,
 
pocafx said:
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. ,
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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.
 
Gern Blansten said:
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.
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Same.
 
Gern Blansten said:
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.
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I've only seen one high spinal in residency and that was how it went as well.
 
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