Complications of Anesthesia
Post-Dural Puncture Headache (PDPH)
- Develops 12-48 hours after spinal anesthesia.
- Headache improves when lying supine.
Mechanisms of PDPH
- Persistent leakage of CSF
- Decrease in CSF volume/pressure
- Shifts of intracranial contents
- Activating adenosine receptors
- Stretching the meninges
- Vasodilatation of intracranial vessels
Differential Diagnosis
- Meningitis
- Sinusitis
- Migraine
- Pregnancy-related hypertension
- Intracranial Pathology (e.g., dural venous thrombosis, pneumocephalus, spontaneous intracranial hypotension)
Treatment
- Conservative
- Epidural blood patch
Other Complications
- Failed block
- Back pain (most common)
- Spinal headache
- Epidural hematoma
- Epidural abscess
- Meningitis
- Cauda equina syndrome
- Neurological deficit
- Transient neurologic symptoms (TNS)
- Bradycardia and cardiac arrest
Primary Treatment: Increase cardiac preload with a large IV fluid bolus within 30 minutes prior to spinal placement.
Secondary Treatment: Pharmacologic (e.g., ephedrine).