Expert: Dr Ian Jackson - please note UK based - 10/10/2006

Question
Hi

I firstly had an epidural during labour but when I was rushed to surgery to have an emergency c-section I had to have a spinal block as the epidural had not taken 100%.  within seconds of having the spinal block administered I was unable to talk and was having difficulty breathing.  My husband was removed from the room and I was ventilated etc.

I am now expecting baby number two and am petrified of experiencing this again. I had a consultants appointment last week and asked him to explain what had happened to me.  He replied that he did not know and I would have to speak to the Anaesthetist at a later date.  I am so anxious.  

What are the chances of this happening again? What caused this.

Any feedback would be very much appreciated.

Jo

Answer
Jo
This can happen. But the explanation is a bit complex without diagrams but I will try my best.
An epidural involves the insertion of a little tube into the epidural space. 'Epidural' basically means 'outside the dura' and so it lies in a space in your back outside the dural membrane. The nerves pass through this area to get to your tummy and legs and we bathe them in local anaesthetic to make you comfortable. Sometimes however this doesn't work very well.
A spinal anaesthetic involves putting a small needle through the dural membrane into the fluid that lies beyond. This fluid is called cerebrospinal fluid and it surrounds all the nerves and spinal cord. We put a small dose of local anaesthetic into this fluid and this very quickly makes you numb for an operation.
So you had an epidural that was working a bit but not completely, however even though it was incomplete there would have been a small degree of block for a long distance up your body. It just cannot be seen clinically as it is so slight but it is there. Indeed a number of patients who have an epidural have evidence of this minor block as high as the nerves in their neck.
When the spinal was added to your incomplete epidural then it blocks the same nerves but from the inside of the dural membrane. Once again this has the effect of providing a dense block low down which then gets weaker as we test the nerves higher in your body. However on this occasion it has obviously been enough to add to the partial block from the epidural to give you what is termed either a 'high block' where your breathing and even swallowing become difficult or a 'total spinal' where you cannot breathe for yourself.
Both of these are frightening and the reason for this should have been explained to you afterwards.
I can fully understand your concerns and indeed I think it would be worth your while having a chat with a Consultant Anaesthetist. However it is unlikely to happen again. If you just have an epidural or just have a spinal anaesthetic then you are on really safe grounds. Even if you have to end up having both again - knowledge of what happened previously should ensure that your anaesthetist uses a much smaller dose of the local anaesthetic to stop this happening again.
I started by saying this was complex and I fear I may well have not been clear enough about this. I apologise about this. Please do not hesitate to ask a further question if you need clarification.
All the best
Dr Ian Jackson