Question:medium
An anaesthesia resident was giving epidural anaesthesia when the patient had sudden aphonia and loss of consciousness. What could have happened?
An anaesthesia resident was giving epidural anaesthesia when the patient had sudden aphonia and loss of consciousness. What could have happened?
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Sudden, transient faint at the moment of instrumentation points to a reflex autonomic event.
Updated On: Jun 24, 2026
- Total spinal anaesthesia
- Anaphylaxis
- Vasovagal attack
- Intravascular injection
Show Solution
The Correct Option is C
Solution and Explanation
Frame the question by the speed and reversibility of the collapse. The patient faints the moment the epidural is being performed, with brief loss of voice and consciousness, which is the signature of a reflex-mediated faint rather than a pharmacological catastrophe.
The autonomic mechanism: noxious stimulation and apprehension during the procedure activate the vagus nerve. The resulting surge in parasympathetic outflow slows the heart and dilates peripheral vessels, so systemic and cerebral pressure drop. The brief global cerebral hypoperfusion explains both the momentary aphonia and the syncope, and recovery is rapid once the patient is laid flat.
Why the other choices do not fit: a total spinal builds up after intrathecal local anaesthetic spreads cephalad and produces apnoea and fixed hypotension over a short interval, not an instantaneous faint at the moment of needle insertion. An anaphylactic reaction would announce itself with skin, airway and circulatory signs together. An intravascular local anaesthetic bolus causes neurological excitation such as tongue numbness, tinnitus and seizures followed by cardiotoxicity. None of these matches a fleeting aphonia plus syncope.
Therefore the episode is a benign autonomic event.
\[\boxed{\text{Vasovagal attack}}\]
The autonomic mechanism: noxious stimulation and apprehension during the procedure activate the vagus nerve. The resulting surge in parasympathetic outflow slows the heart and dilates peripheral vessels, so systemic and cerebral pressure drop. The brief global cerebral hypoperfusion explains both the momentary aphonia and the syncope, and recovery is rapid once the patient is laid flat.
Why the other choices do not fit: a total spinal builds up after intrathecal local anaesthetic spreads cephalad and produces apnoea and fixed hypotension over a short interval, not an instantaneous faint at the moment of needle insertion. An anaphylactic reaction would announce itself with skin, airway and circulatory signs together. An intravascular local anaesthetic bolus causes neurological excitation such as tongue numbness, tinnitus and seizures followed by cardiotoxicity. None of these matches a fleeting aphonia plus syncope.
Therefore the episode is a benign autonomic event.
\[\boxed{\text{Vasovagal attack}}\]
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