UPSC-CMS 2009 — Anesthesiology

Question 1: Contraindications to epidural analgesia include the following except

• A. Hypertension (Correct Answer)
• B. Infection over the back
• C. Raised intracranial pressure
• D. Coagulopathy

Explanation: ***Hypertension*** - While careful monitoring is needed, **uncontrolled hypertension** is not an absolute contraindication to epidural analgesia. - Epidural analgesia can sometimes even help to lower blood pressure, which might be beneficial in certain hypertensive patients. *Infection over the back* - This is a significant contraindication due to the risk of introducing bacteria into the **epidural space**, leading to severe infections like **epidural abscess** or **meningitis**. - A local infection could spread to the central nervous system, causing grave complications. *Raised intracranial pressure* - This is a contraindication because a sudden decrease in **cerebrospinal fluid pressure** from epidural needle insertion can exacerbate herniation in patients with **raised ICP**. - The procedure itself can further alter intracranial dynamics, posing a significant risk. *Coagulopathy* - **Coagulopathy**, whether due to medication (e.g., anticoagulants) or a pre-existing medical condition, is a major contraindication. - There is an increased risk of **epidural hematoma**, which can compress the spinal cord and lead to permanent neurological damage.