The Chloroprocaine Controversy: I. A Hypothesis to Explain the Neural Complications of Chloroprocaine Epidural

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Epidural anesthesia using chloroprocaine (especially in the pregnant woman) has recently been associated with a number of persistent serious neurological complications. Fortunately, this occurrence is infrequent but the underlying causes are unknown. We present the thesis that the complications seen (anterior spinal artery syndrome, cauda equina syndrome) are vascular in origin. The basic cause of clinical complications is a “waterfalls phenomenon,” following the introduction of excessive fluid volume intrathecally associated with systemic hypotension. Serious decrease in tissue perfusion results from cerebrospinal fluid hypertension because of low spinal space compliance and decreased vascular perfusion pressure. We suggest a therapeutic regime in the presence of a total spinal following an attempted epidural block.

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