“High Spinal” Risk: Respiratory Compromise

High or total spinal anesthesia refers to the administration of local anesthetic agents at a level near the upper thoracic or cervical spine, resulting in a block of sensation and motor function in the body (1). This type of anesthesia is typically used for surgeries involving the upper abdomen, chest, or neck, providing a more extensive area of numbness compared to lower spinal anesthesia. Unfortunately, high spinal anesthesia can cause respiratory complications due to its effects on the nerves that control the diaphragm and other respiratory muscles. Respiratory complications associated with high spinal anesthesia include difficulty breathing, decreased lung function, and in severe cases, respiratory failure (2). Understanding these effects is critical for anesthesiologists and other anesthesia providers to ensure patient safety and optimize outcomes during surgical procedures.

It is important for anesthesia providers to carefully monitor the patient’s oxygen saturation levels, end-tidal carbon dioxide levels, and respiratory effort to identify potential complications early. In addition, maintaining proper patient positioning during surgery can help prevent respiratory problems associated with high spinal anesthesia (1). Overall, a proactive approach to managing respiratory changes during surgery plays a critical role in ensuring patient comfort and successful postoperative outcomes. This proactive approach includes closely monitoring the patient’s vital signs, such as heart rate and blood pressure, and assessing for signs of respiratory distress, such as increased work of breathing or cyanosis. Surgeons may need to modify their approach or technique to minimize the risk of respiratory complications, while nurses play a key role in monitoring the patient’s response to interventions and providing support as needed (2).

For example, if a patient undergoing surgery begins to show signs of respiratory distress, such as shallow breathing or decreased oxygen saturation, the anesthesia provider may need to increase ventilatory support or administer supplemental oxygen. The surgeon may need to adjust his or her technique to reduce pressure on the patient’s chest or airway, while the nursing staff provides close assistance as needed to ensure optimal respiratory function (3). Effective communication and teamwork are essential to ensure that all members of the healthcare team work together to prioritize the patient’s respiratory health and overall well-being.

In the postoperative period after high spinal anesthesia, it is also critical that providers closely monitor the patient’s vital signs and oxygen saturation to detect early signs of respiratory distress, as risk does not disappear immediately. Prompt intervention and collaboration between the surgical team, nursing staff, and respiratory therapists can help prevent complications and improve the patient’s recovery process (3).  In addition, patient education on deep breathing exercises and early mobilization can play an important role in promoting optimal respiratory function and preventing postoperative complications. This comprehensive approach to respiratory care may also include appropriate pain management to promote deep breathing and coughing, as well as implementing early mobilization strategies to prevent atelectasis and pneumonia (1). By implementing a multidisciplinary approach and emphasizing the importance of respiratory care, healthcare providers can improve patient outcomes and ensure a smooth recovery process after surgery.


  1. Aronson JK. Anesthetics, local. In: Meyler’s Side Effects of Drugs. 16th ed. Elsevier; 2015
  2. Sharma J, Bala R, Kumar R, Malhan S. Respiratory arrest after spinal anaesthesia: a conundrum for anesthesiologists. Research and Opinion in Anesthesia and Intensive Care. 2019;6(3):377. doi:10.4103/roaic.roaic_51_18
  3. Foster LA, Deutz CK, Hutchins JL, Allen JA. Total spinal and brainstem anesthesia as complication of paravertebral ropivacaine administration. Neurol Clin Pract. 2017;7(5):430-432. doi:10.1212/CPJ.0000000000000355