Korean J Anesthesiol.  2013 Jun;64(6):529-532. 10.4097/kjae.2013.64.6.529.

Intrauterine fetal bradycardia after accidental administration of the anesthetic agent in the subdural space during epidural labor analgesia: A case report

• Moon HS
• Chon JY
• Yang WJ
• Lee HJ

• KMID: 1767437
• DOI: http://doi.org/10.4097/kjae.2013.64.6.529

Abstract

Subdural injection of epidural anesthesia is rare and is usually undiagnosed during epidural anesthesia causing severely delayed maternal hypotension, hypoxia, and fetal distress. A 38-year-old primiparous woman was administered epidural labor analgesia at 40(+6) weeks' gestation, and developed progressive maternal respiratory depression, bradycardia, and hypotension after accidental subdural administration of the anesthetic agent. Furthermore, fetal distress occurred soon after administration. The patient was managed with oxygen, position changes, fluid resuscitation, and ephedrine. Intrauterine fetal resuscitation was successfully performed with atropine before cesarean section, and a healthy baby was delivered. Although subdural injection is uncommon, this case emphasizes the importance of anesthesiologists monitoring patients for a sufficient period after epidural labor analgesia, and being prepared to perform maternal or fetal resuscitation.

Keyword

Atropine; Epidural analgesia; Fetal bradycardia; Resuscitation; Subdural injection

MeSH Terms

Analgesia
Analgesia, Epidural
Anesthesia, Epidural
Anoxia
Atropine
Bradycardia
Cesarean Section
Ephedrine
Female
Fetal Distress
Humans
Hypotension
Oxygen
Pregnancy
Respiratory Insufficiency
Resuscitation
Subdural Space
Atropine
Ephedrine
Oxygen