PURPOSE: Spinal anaesthesia is selected for many lower extremity surgical procedures each year in the United States with a high degree of safety and efficacy. Even when adverse neurological outcomes have occurred, @entity854 or @entity1003 have been implicated in the majority of cases. @entity1425 is used in high concentrations in many of these anaesthetics to increase the duration and intensity of the block. Although @entity1425 is known to decrease spinal cord blood flow, its use in normal @entity1 has not caused complications. We report a case where spinal anaesthesia with @entity1341 and @entity1425 resulted in anterior spinal artery compromise and the development of a @entity1971 postoperatively. CLINICAL FEATURES: A 57-yr-old @entity1 with severe coronary artery and @entity1095 was scheduled for incision and drain of an abscess of the left thigh. He received an atraumatic dural puncture and injection of 12.5 mg @entity1341 with 0.2 ml 1:1000 @entity1425 . During onset, he experienced a severe, @entity158 sensation of the thighs which resolved with development of the block. Postoperatively, he was noted to have exacerbation of proximal @entity425 and @entity1109 and rectal tone. Subsequent EMG studies demonstrated proximal neuron loss consistent with @entity1971 , presumed to be related to insufficiency of the anterior spinal artery. CONCLUSION: Routine use of @entity1425 in spinal anaesthesia for @entity1 with multi-organ @entity455 should be considered carefully because of the possibility of @entity5327 of the spinal cord which would be exaggerated by the vasoconstrictive effect of @entity1425 .

XXXX after spinal anaesthesia in a @entity1 with severe @entity455 .

@entity1 :: ('9606', 'Species') :: ['patients', 'man'] @entity1095 :: ('MESH:D016491', 'Disease') :: ['peripheral vascular disease'] @entity455 :: ('MESH:D014652', 'Disease') :: ['vascular disease'] @entity1425 :: ('MESH:D004837', 'Chemical') :: ['epinephrine', 'Epinephrine'] @entity1109 :: ('MESH:D012678', 'Disease') :: ['decreased perineal sensation'] @entity1003 :: ('MESH:D001778', 'Disease') :: ['coagulopathy'] @entity425 :: ('MESH:D018908', 'Disease') :: ['muscle weakness'] @entity1341 :: ('MESH:D002045', 'Chemical') :: ['bupivacaine'] @entity854 :: ('MESH:D018376', 'Disease') :: ['anatomical abnormality'] @entity158 :: ('MESH:D010146', 'Disease') :: ['painful'] @entity1971 :: ('MESH:D011128', 'Disease') :: ['cauda equina syndrome'] @entity5327 :: ('MESH:D065666', 'Disease') :: ['vascular insufficiency']
@entity1971 :: (MESH:D011128,Disease) :: ['Cauda equina syndrome']
