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High spinal block — FRCA Final MCQ

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EasyRegional AnaesthesiaHigh spinal blockFRCA Final

A 77-year-old woman receives a spinal anaesthetic for dynamic hip screw fixation. Five minutes later she reports dyspnoea, cannot lift her arms, has a weak voice, heart rate 42/min and blood pressure 65/35 mmHg. What is the most likely cause of the complication?

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Correct answer: D — High spinal block causing cardio-respiratory compromise

The rapid onset after spinal injection, arm weakness, weak voice, bradycardia and hypotension indicate a high spinal block. Pulmonary embolism or myocardial infarction are differentials, but the tight temporal relationship and neurological level are key. Management is supportive: call for help, airway/ventilation, vasopressors, fluids and preparation for intubation. Early recognition prevents arrest.

Reference: RCoA Final FRCA Syllabus 2026; Association of Anaesthetists neuraxial safety guidance