A surgeon decides to operate a patient under epidural anesthesia. 3% Xylocaine with adrenaline is used for administering epidural anesthesia. The patient suddenly develops hypotension after 3 minutes of administration. What is the most likely cause for this?
(A) Systemic absorption of the drug (B) Vasovagal effect (C) Allergy to the drug preparation (D) Penetration into the subarachnoid space
(D) Ans: D. Penetration into the subarachnoid space(Ref: Miller 7/e p1895: Barash 5/e p1478, 2405)Penetration of drug into the subarachnoid space sholy causes cardiovascular symptoms like hypotension.Systemic absorption of drugs causes neurological symptoms before hypotension.Vasovagal shock occurs immediately, i.e. even before the needle for epidural anesthesia is injected.