BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.
Anesthesia, Epidural* ; Bupivacaine ; Humans ; Injections, Epidural ; Lower Extremity* ; Needles

Pulmonary aspiration of gastric contents is the main cause of anesthesia-related maternal deaths. We experienced a case of pulmonary aspiration during induction of general anesthesia for an emergency cesarean section. The parturient was admitted for severe abdominal pain and abnormal fetal movement. She had no remarkable past medical history except for an appendectomy, 3 years earlier. The massive pulmonary aspiration of acid-liquid, malodorous feculent, gastric contents occurred accidently. Immediate endotracheal intubation and suction were followed. The strangulation ileus of the small bowel resulting from the pressure of the enlarged uterus on intestinal adhesions was detected after cesarean delivery and severe pulmonary edema developed during the perioperative period. Intensive care including mechanical ventilation with positive end-expiratory pressure, frequent suction, antibiotic therapy and other measures was attempted. At the 50th day after the operation the patient was discharged fortunately without any meaningful pulmonary sequelae. In conclusion, we should be aware of the possibility of mechanical ileus and pulmonary aspiration in parturients with past abdominal operation histories during anesthesia for cesarean section.
Abdominal Pain ; Anesthesia ; Anesthesia, General* ; Appendectomy ; Cesarean Section ; Emergencies ; Female ; Fetal Movement ; Humans ; Ileus* ; Critical Care ; Intubation, Intratracheal ; Maternal Death ; Perioperative Period ; Pneumonia* ; Positive-Pressure Respiration ; Pregnancy ; Pulmonary Edema ; Respiration, Artificial ; Suction ; Uterus