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Complications of Spinal and Epidural Anesthesia
Complications of Spinal and Epidural Anesthesia
Epidural Anesthesia
Dr. Shikha Shah
Cardiovascular complications
• Hypotension: defined as systolic blood pressure
<90mmHg.
• It is more likely to occur with variety of factors like
1. peak block height greater than or equal to T5,
2. age older than or equal to 40 yrs,
3. baseline systolic blood pressure less than 120mmHg,
4. combined spinal and general anesthesia,
5. spinal puncture at or above the L2-L3 interspace,and
the addition of phenylephrine to the local anesthetic.
• Hypotension is the result of both arterial and
venodilation.
• Venodilation increases volume in capacitance
vessels, thereby decreasing venous return and right-
sided filling pressures.
• This fall in preload is the principal cause of
decreased cardiac output during high spinal
anesthesia.
• Arterial dilation results in significant decrease in total
peripheral resistance. Thus, the hypotension may be
the result of reductions in afterload, reductions in
cardiac output, or both.
• Prevention include (preloading ) infusion of colloid or
crystalloid.
• Bradycardia:
• The risk of bradycardia increases with increasing block height.
• The mechanism responsible for bradycardia is not clear.
Blockade of the sympathetic cardioaccelerator fibers
originating from T1-4 spinal segments is often suggested as
the cause.