Question

A patient with Raynaud's Syndrome develops severe vasospasm in both upper extremities and is referred for stellate ganglion blocks. Bilateral blockade is performed. Within a few minutes, the patient begins to exhibit and desaturates to 75% despite 6 L oxygen via nasal cannula. With bag-valve mask ventilation, synchronized to her respiratory effort, she is able to oxygenate and on room air. What has most likely occurred?

A. Bilateral phrenic nerve paralysis
B. Epidural spread of local anesthetic
C. Total spinal anesthesia
D. Bilateral recurrent laryngeal nerve paralysis
E. Paratracheal hematoma

Answer 1

The patient most likely experienced an epidural spread of local anesthetic, leading to high spinal anesthesia and subsequent respiratory distress.

Step-by-step explanation:

A patient who develops severe vasospasm in both upper extremities with Raynaud's Syndrome and undergoes bilateral stellate ganglion blocks showing desaturation to 75% despite oxygen administration has most likely experienced B. Epidural spread of local anesthetic. The bilateral spread of local anesthetic to the vertebral epidural space can lead to high spinal anesthesia, which can result in respiratory distress due to the high-level blockade affecting the phrenic and intercostal nerves, leading to paralysis of the diaphragm and respiratory muscles.