Question

A woman in labor has an epidural catheter and is being prepared for a cesarean section delivery, when she begins complaining of ringing in her ears. You should be most concerned that what is occurring?

A) Epileptic seizure; ringing in the ears is a symptom of seizures
B) High spinal, because the epidural catheter may be intrathecal
C) Hypotension, because the block is setting up quickly
D) Early signs of local anesthetic systemic toxicity (LAST), because the epidural catheter may be intravascular
E) Cardiac arrhythmia due to local anesthetic

Answer 1

Ringing in the ears of a woman in labor with an epidural catheter can be an early sign of local anesthetic systemic toxicity (LAST), which is a medical emergency requiring immediate treatment to avoid severe complications.

Step-by-step explanation:

If a woman in labor with an epidural catheter begins complaining of ringing in her ears during preparation for a cesarean section, the most concerning potential cause is D) Early signs of local anesthetic systemic toxicity (LAST). This condition can occur if the epidural catheter has been placed intravascularly. Symptoms can also include neurologic and cardiac symptoms. The concern here is not primarily epileptic seizures, high spinal events, hypotension, or cardiac arrhythmias due to local anesthetic, but rather the urgent possibility of LAST, which requires immediate recognition and treatment to prevent more severe systemic effects such as seizures or cardiac arrest.