D

Rapid, marked hypotension a few minutes after dosing an epidural is most often due to unintentional entry of the local-anesthetic solution into the subarachnoid space, producing an unexpectedly high spinal block and profound sympathetic blockade. Case reports describe sudden severe hypotension within minutes when an epidural test dose or bolus is inadvertently injected intrathecally, exactly as seen here [Richardson, 1996, PMID 8829404; Fiedler, 1997, PMID 9281920].