Syncopal Attack! - A Rare Complication after Whitacre Spinal Needle Insertion during Spinal Anaesthesia

Abstract

Fine gauze spinal needles are known to decrease the incidence of postdural puncture headache (PDPH) in patients undergoing spinal anaesthesia. We present a rare case of syncopal attack in a patient posted for caesarean section. A patient undergoing elective surgery with inadequate anxiolysis can have a rare chance of a syncopal attack. Hence, high level of suspicion and management of a vasovagal attack is vital. The most common mechanism of syncope is reflex mediated, which can be ‘neurally’ or ‘vasovagally’, and it characteristically develops in the sitting or upright position but may occur in supine position also.1,2 It is characterized by a rapid onset, brief duration, and with a spontaneous recovery. Anxious and apprehensive patients prior to any surgical or anaesthetic procedure can lead to a vasovagal syncope, especially in young females.3 Medline search did not reveal any case report regarding the vasovagal syncope just after spinal needle insertion in young females undergoing spinal anaesthesia. Spinal anaesthesia is the most common anaesthesia performed for lower segment caesarean section (LSCS). A case of syncopal attack with sequence of events, during the insertion of a 25 G Whitacre spinal needle, in a parturient posted for emergency lower segment caesarean section, is discussed here.