Is spinal anesthesia after failed epidural anesthesia contraindicated for cesarean section?

n a recent review article on spinal anesthesia for cesarean section (l), Kestin recommended the use I of subarachnoid anesthesia if epidural block was inadequate after the administration of the maximum allowable dose of local anesthetic (2). The use of spinal anesthesia in obstetrics has also been advocated for patients with potentially difficult airways, as this approach usually would obviate the need for general anesthesia and endotracheal intubation (3,4). From these statements, it might be construed that spinal anesthesia, rather than general anesthesia, would be safer under circumstances in which epidural block for cesarean section has failed in a patient with a potentially difficult airway. Two recent reports (2,5), and the following case report, suggest that subarachnoid anesthesia may be specifically contraindicated under these circumstances.