A patient was administered epidural anesthesia with 15 ml of 1.5%. Lignocaine with adrenaline for hernia surgery. He developed hypotension and respiratory depression within 3 minutes after administration of block. The most common cause would be:

Ans. is 'd' i.e., Drug has entered the subarachnoid space Sometimes during epidural analgesia, due to inadvertent suparachnoid injection (i.e. the injection enters the subarachnoid space) a condition termed "total spinal analgesia" is produced. It is produced because large dose of drug which is used in epidural anaesthesia enters the subarachnoid space. (Note: The dose used for subdural anaesthesia is very low compared to epidural anaesthesia) The manifestation of total spinal analgesia are- Marked hypotension Apnoea Dilated pupils Management Patient should be immediately intubated and 100% 02 should be given I.V. fluids and vasopressors should be given