Hypoxic-ischaemic brain injury secondary to cardiac arrest from spinal anaesthesia: A case report

Abstract

BACKGROUND: Hypoxic-ischaemic brain injury is usually due to cardiac arrest or severe hypotension. The clinical manifestation and outcome will depend on the severity of the initial insult, the promptness and effectiveness of the resuscitation, and the post resuscitation management in the intensive care unit. OBJECTIVE: To highlight the need for vigilance and preparedness in every case of spinal anaesthesia. CASE REPORT: Patient was a 32years old housewife who was booked for emergency lower segment caesarean section on account of transverse lie in labour at term. She had no co-morbidities. A subarachnoid block was established with a 25G Quinke needle through L3 – L4 intervertebral space using 2ml of 0.5% heavy bupivacaine, after preloading, she was then wedged in a left lateral tilt. Five minutes after this procedure, and before the commencement of surgery, the patient had a cardiac arrest. She was resuscitated, intubated, ventilated, and delivered of a live asphyxiated baby. She was then transferred to the intensive care unit, where she eventually made a full recovery. CONCLUSION: While hypoxic-ischaemic brain injury is not commonly associated with spinal anaesthesia, vigilance, and prompt and aggressive management is key to a favourable outcome.

Keywords

• spinal anaesthesia
• hypotension
• cardiac arrest
• hypoxic-ischaemic brain injury