Adhikari Gauri, Ghimire Suson, Adhikari Gopal, Aryal Krishnaraj, Kandel Narayan
Department of Anaesthesia Nepalese Army Institute of Health Sciences- College of Medicine Kathmandu Nepal.
Department of Anaesthesia Patan Academy of Health Sciences (PAHS) Patan Nepal.
Clin Case Rep. 2023 Oct 6;11(10):e7979. doi: 10.1002/ccr3.7979. eCollection 2023 Oct.
Subarachnoid block with local anesthetic agents is a well-established anesthesia technique among pregnant females for labor analgesia and cesarian delivery. Although it is considered a reliable and safe technique for both mothers and fetuses, unexpected high or low levels of block may occur due to accidental injection of these agents into different meningeal spaces other than intended. Hypotension, bradycardia, headache, and failed anesthesia are common complications of spinal anesthesia. Though rare, neurological complications like aphonia, dysphagia, and tingling sensation have also been reported. The article reports a case of a 22-year-old primigravida who sustained transient aphonia following intrathecal administration of bupivacaine for an emergency cesarian section for meconium-stained liquor with fetal distress. There were no other neurological manifestations or features suggestive of high spinal block. The sensory level of the block was fixed to T6 with hemodynamic stability throughout aphasia with an episode of hypotension preceding aphonia. Aphonia commenced 9 min after the spinal anesthesia continued for a total duration of 15 min. Neurological examination, relevant investigations, and consultations were done to make a diagnosis. Thus, it is important to be aware of the possible neurological complications associated with spinal anesthesia.
使用局部麻醉药进行蛛网膜下腔阻滞是孕妇分娩镇痛和剖宫产中一种成熟的麻醉技术。尽管它被认为对母亲和胎儿都是可靠且安全的技术，但由于这些药物意外注入到预期以外的不同脑膜间隙，可能会出现意外的高或低平面阻滞。低血压、心动过缓、头痛和麻醉失败是脊麻的常见并发症。虽然罕见，但也有报道称出现如失音、吞咽困难和刺痛感等神经并发症。本文报道了一例22岁初产妇的病例，该产妇因胎儿窘迫、羊水粪染行急诊剖宫产，鞘内注射布比卡因后出现短暂性失音。没有其他神经表现或提示高位脊麻的特征。阻滞的感觉平面固定在T6，在失音期间血流动力学稳定，失音前有一次低血压发作。失音在脊麻9分钟后开始，持续总时长15分钟。进行了神经检查、相关检查和会诊以做出诊断。因此，了解与脊麻相关的可能神经并发症很重要。
