High and Total Spinal Anesthesia Management - Clinical Protocol 2025
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1. DEFINITION
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High spinal: Excessive cephalad spread of local anesthetic causing cardio-respiratory compromise.
Total spinal: Spread into cervical and intracranial region leading to loss of consciousness and
apnea.
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2. RECOGNITION - EARLY & LATE SIGNS
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Early: Rising sensory block above T4, tingling in hands/arms, weak voice, hypotension, bradycardia.
Late: Respiratory paralysis, loss of consciousness, dilated pupils, cardiac arrest.
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3. IMMEDIATE MANAGEMENT (STEP-BY-STEP)
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STEP 1 - STOP PROCEDURE
- Stop any epidural/top-up infusion immediately.
- Call for help: anesthesia and resuscitation team.
STEP 2 - AIRWAY & BREATHING
- Administer 100% oxygen via face mask.
- Assist ventilation if needed. Intubate if apneic/unconscious.
------------------------------------------------------------
1. DEFINITION
------------------------------------------------------------
High spinal: Excessive cephalad spread of local anesthetic causing cardio-respiratory compromise.
Total spinal: Spread into cervical and intracranial region leading to loss of consciousness and
apnea.
------------------------------------------------------------
2. RECOGNITION - EARLY & LATE SIGNS
------------------------------------------------------------
Early: Rising sensory block above T4, tingling in hands/arms, weak voice, hypotension, bradycardia.
Late: Respiratory paralysis, loss of consciousness, dilated pupils, cardiac arrest.
------------------------------------------------------------
3. IMMEDIATE MANAGEMENT (STEP-BY-STEP)
------------------------------------------------------------
STEP 1 - STOP PROCEDURE
- Stop any epidural/top-up infusion immediately.
- Call for help: anesthesia and resuscitation team.
STEP 2 - AIRWAY & BREATHING
- Administer 100% oxygen via face mask.
- Assist ventilation if needed. Intubate if apneic/unconscious.
