A 25 year old G2P, at 39 weeks gestation is electing to have spinal anaesthesia for a repeat cesarean section. 5 minutes after bupivacaine spinal injection, the patient becomes hypotensive and is complaining of tingling in her fingers with subjective difficulty breathing. Her oxygen saturation remains 100% and blood pressure in 90/60 mmHg The most likely etiology is.
In pregnancy, CSF volume is decreased, thereby decreasing dose requirement of local anaesthetic. This facilitates spread of local anaesthetic when spinal anaesthesia is given.
Option D would have been correct, if question mentioned Epidural anaesthesia.
Severe patient anxiety
Increased peripheral nerve sensitization to local anaesthetics
Decrease in volume of CSF in subarachnoid space facilitated higher spread of local anaesthetics
Engorgement of epidural veins contributed to inadvertent intravascular injection of local anaesthetic