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High Spinal Block in Obstetrics — FRCA Final MCQ

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ModerateObstetric AnaesthesiaHigh Spinal Block in ObstetricsFRCA Final

A 40-year-old woman is undergoing emergency caesarean birth under spinal anaesthesia with 2.5 mL hyperbaric bupivacaine 0.5% and diamorphine 300 micrograms. Five minutes after injection, she develops nausea and breathlessness. The sensory block is T2 bilaterally, blood pressure is 78/42 mmHg and heart rate is 92 beats min−1. There is no evidence of haemorrhage. Alongside calling for help, giving oxygen, maintaining left uterine displacement and assessing the airway, what is the most appropriate immediate circulatory management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Rapidly infuse balanced crystalloid with titrated phenylephrine

Explanation lettering: D = shown as B · B = shown as C · E = shown as D · C = shown as E

D is correct. This is a high spinal block causing extensive sympathetic blockade, reduced systemic vascular resistance and marked hypotension. Immediate management is an ABCDE response: call for help, oxygen, left uterine displacement, rapid crystalloid administration and a titrated vasopressor. With a heart rate of 92 beats min−1, phenylephrine is an appropriate initial vasopressor, while reassessment is continuous because bradycardia or cardiovascular collapse may require anticholinergic treatment and escalation of vasopressor support. Crystalloid alone (A or E) is too slow and does not directly restore vascular tone. Phenylephrine without a fluid bolus (C) omits fluid support included in the recommended resuscitation approach. Colloid is not required (B); balanced crystalloid is the appropriate initial fluid in this setting.

Reference: Royal College of Anaesthetists. High spinal – Obstetric simulation. September 2023. https://rcoa.ac.uk/sites/default/files/documents/2023-10/Obstetrics%20-%20High%20spinal%200923.pdf