Author: Hadri A O et al.
Cureus 17(10), October 2025. DOI: 10.7759/cureus.95774
This case report describes a 28-year-old woman with sickle cell disease who experienced cardiac arrest due to high spinal anesthesia during a cesarean section. The patient, initially receiving epidural analgesia for labor, required conversion to surgical anesthesia after fetal distress developed. Following a bolus of lidocaine, she developed progressive weakness, apnea, bradycardia, and asystole—hallmark features of an excessively high neuraxial block. Immediate resuscitation, including epinephrine, atropine, phenylephrine, and chest compressions, restored spontaneous circulation within two minutes. She was intubated, stabilized, and transferred to the surgical ICU, later extubated and discharged without neurological or cardiac sequelae.
The report highlights that high spinal anesthesia, though uncommon, represents one of the most life-threatening complications of obstetric anesthesia. Risk factors include obesity, short stature, repeated epidural attempts, and excessive local anesthetic dosing. Pregnant patients, especially those with comorbidities such as sickle cell disease, are at greater risk due to physiologic changes that reduce cerebrospinal fluid volume and increase anesthetic spread. Early signs such as dyspnea, upper extremity weakness, or bradycardia must be recognized immediately. Prompt airway management, vasopressor support, and team coordination are essential for successful outcomes.
The authors also stress that in sickle cell disease, hemodynamic instability and hypoxia are especially dangerous, potentially worsening vaso-occlusive risks and organ injury. Tailored dosing, incremental testing, and vigilant monitoring should therefore be standard for such high-risk obstetric patients.
What You Should Know
High spinal anesthesia can rapidly progress to cardiac arrest during cesarean delivery, especially in high-risk patients like those with sickle cell disease. Preventive measures include careful dosing, test aspiration, incremental injection, and readiness for immediate airway and cardiovascular support. Interdisciplinary preparedness and simulation-based team training can markedly improve maternal survival.
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