Total Spinal Anaesthetic

This a rare complication that may occur with or without a recognised dural puncture. A total spinal results in unconsciousness, apnoea, bradycardia, hypotension and dilated pupils.

The patient has a rapidly rising block. They may first complain of dyspnoea or hand weakness before progressing to apnoea.

Management of a total spinal anaesthetic

Call for help early-use a MET call or Code Blue

Call for the resuscitation trolley, airway equipment and monitoring

Put in a wedge for left lateral tilt.

Secure the airway with an endotracheal tube if possible. Use a laryngeal mask if the airway is difficult. A proseal is ideal.

Ventilate with a self inflating bag

Support the circulation with IV fluid and inotropes as required

Monitor the mother and foetus continuously

Move the patient to somewhere safe...eg recovery

The patient may later require sedation as consciousness returns before airway reflexes and respiratory function.

Reasses after 1 to 2 hours to see if the patient is extubatable.