Regional anaesthesia: total spinal after epidural top-up: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Regional anaesthesia: total spinal after epidural top-up

Sample item

Within minutes of an epidural top-up for caesarean section, a parturient becomes hypotensive and bradycardic, stops breathing and has dilated pupils. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Secure the airway and ventilate, maintain left uterine displacement, and give fluids and vasopressors

This picture suggests a total spinal block from inadvertent intrathecal or subdural placement of the epidural dose. Management is supportive, with early intubation and ventilation, left uterine displacement, fluids, vasopressors and atropine, with delivery if the mother arrests. The block resolves over time as the drug wears off.

Option by option

  • A. Position head up at 45 degrees and give oxygen by mask only

    Oxygen by mask alone does not treat apnoea, and head-up positioning worsens hypotension.

  • B. Give neostigmine to reverse the block

    Neostigmine does not reverse the sensory and motor block of local anaesthetics.

  • C. Give 20% lipid emulsion as the primary treatment

    Lipid emulsion treats local anaesthetic systemic toxicity, which does not usually cause this immediate picture.

  • D. Secure the airway and ventilate, maintain left uterine displacement, and give fluids and vasopressors (correct)

    Correct. Airway and circulatory support is the treatment of a high block until it recedes.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Secure the airway and ventilate, maintain left uterine displacement, and give fluids and vasopressors. This picture suggests a total spinal block from inadvertent intrathecal or subdural placement of the epidural dose.

Why is "Position head up at 45 degrees and give oxygen by mask only" not the answer?

Oxygen by mask alone does not treat apnoea, and head-up positioning worsens hypotension.

Why is "Give neostigmine to reverse the block" not the answer?

Neostigmine does not reverse the sensory and motor block of local anaesthetics.

Why is "Give 20% lipid emulsion as the primary treatment" not the answer?

Lipid emulsion treats local anaesthetic systemic toxicity, which does not usually cause this immediate picture.

What concept does this question test?

It tests Regional anaesthesia: total spinal after epidural top-up in Anaesthesia. Management is supportive, with early intubation and ventilation, left uterine displacement, fluids, vasopressors and atropine, with delivery if the mother arrests. The block resolves over time as the drug wears off.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Regional anaesthesia: total spinal after epidural top-up?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.