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2899 Anaesthesia

After performing a single-shot intrathecal anaesthetic consisting of 6.5mg of preservative free bupivacaine and 25 ug of fentanyl, the surgical incision is made and systemic hypotension ensued. To avoid significant decrease in uterine blood flow, first-line therapy to consider is

AProvide additional inhaled nitric oxide to vasodilate the uterine vasculature
BIncrease maternal cardiac output with use of epinephrine
CIncrease intravascular volume with fluids
DUse reverse Trendelenburg to decrease aortocaval compression
Anaesthesia
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2907 Anaesthesia

A 25 year old G2P, at 39 weeks gestation is electing to have spinal anaesthesia for a repeat cesarean section. 5 minutes after bupivacaine spinal injection, the patient becomes hypotensive and is complaining of tingling in her fingers with subjective difficulty breathing. Her oxygen saturation remains 100% and blood pressure in 90/60 mmHg The most likely etiology is.

ASevere patient anxiety
BIncreased peripheral nerve sensitization to local anaesthetics
CDecrease in volume of CSF in subarachnoid space facilitated higher spread of local anaesthetics
DEngorgement of epidural veins contributed to inadvertent intravascular injection of local anaesthetic
Anaesthesia
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