High Spinal

[IlDestriero]

This case makes no sense at all!
They are suggesting that the patient had a complete spinal following 5 mg Bupivacaine and 20 mcg Fentanyl that manifested as respiratory arrest and loss of consciousness without hypotension and only mild bradycardia!
Further, they say that the patient actually became hypertensive and they had to treat that hypertension.
My humble opinion here: This was an overdose of intrathecal Fentanyl and what they thought was 20 mcg maybe was more.
Only a high dose intrathecal fentanyl would logically produce this respiratory arrest without hemodynamic compromise.
Now even 20mcg of fentanyl could be too much for a tiny 80 Y/O lady but most likely they inadvertently gave more and then they came up with this fantastic theory and case report.
We all have seen these type of cases where people try to come up with magical explanations to justify a stupid error.

Open access journal, one step below a meeting poster that doesn't make it to publication.
It's farcical. I'd love to see who edits that crap, but don't care enough to try to look.


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Il Destriero

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[Noyac]

Yep that's how I learned in residency. Was combined with 20mg of versed. Old school TIVA. Not very elegant. And when I got out, the PP guys were using low dose inhalation agent and propopol. They were ahead of academics.

Exactly.

 

[Planktonmd]

How can you make the difference?
A couple of nice studies handled that for our benefit...

It can be seen in an intubated patient if no muscle relaxant is given, that's how I know it's not vocal cords spasm.

 

[Planktonmd]

One of my staff cardiac anaesthesics regular shopping list for me to prepare in the morning was 2mg of fentanyl. He gave almost every single cabg about 30ccs in the 20 mins it took me to do the neck line and art line. I personally didn't see this rigidity nor did he say it was much of an issue

The first time he did it with me I nearly passed out with shock!

He gave it over 20 minutes... that's your answer.

 

[deleted162650]

The whole "chest-wall rigidity v. laryngeal spasm" is one of the more ******ed debates we have (both on SDN and as a specialty). Opioids cause involuntary muscle contraction with rapid titration of high doses - that is a fact. I don't really care where it's occurring, because treatment is the same. Not only that, but maybe - just maybe both the larynx and chest wall is involved. I don't see why everyone needs to believe it's only one or the other. Ever notice that little cough pts sometimes get when you push a couple cc's of fent pre-induction? That's some minor laryngeal spasm. No reason to believe it couldn't be worse with a large dose. I have also seen full-on damn near de-corticate style posturing from high dose fent (in the absence of any other meds) so I'm sure the chest wall was a factor there as well.