Hemodynamic collapse with cardiac arrest during a high subarachnoid block

Background: In this case report we tried to identify possible factors which could be related to developing an inappropriately high subarachnoid block and consequential hemodynamic collapse. Case report: A 59 year old female patient was predicted for a lower extremity peripheral revascularization procedure.The progressive spread of spinal block with a decrease in blood pressure and slowing of heart rate ultimately resulted i naab radycardia which lead to cardiac arrest. Since known risk factors were inapparent and CSF volume as a possible reason for the high block was excluded, we measured the segment length from the Th12 to the L5 vertebra with an MRI scan. Values for the respective parameters of lumbar segment length, angle of inclination and declination, lowest and highest points of the spinal canal which can be obtained from existing literature were compared to our results and we saw that the lumbar segment length and angle of inclination were not within the described ranges and that the lowest point of the spinal canal was at the cranial margin of the values described in literature. Thus we considered if the shorter lumbar segment and lowest spinal canal point at the Th7 level are responsible for the cranial distribution of the subarachnoid block. Conclusion: Lumbar segment length, AP and LL diameters of the spinal canal and the lowest spinal canal point could help us identify higher risk groups which might require a modified dose of LA in order to assure optimal care for the patient.