Key result
Thoracic combined spinal epidural enables successful high-risk abdominal surgery in an ASA 5 patient.
Why the study?
Regional anaesthesia is recommended over general anaesthesia for compromised elderly patients, but data on thoracic combined spinal epidural anaesthesia in ASA5 patients undergoing abdominal surgery are limited.
Case Report (n=1)
Thoracic combined spinal epidural anaesthesia can be successfully utilized for major abdominal surgery in highly compromised (ASA5) elderly patients.
Answers are grounded in this paper and cite their sources.
May support thoracic CSE in select ASA5 cases; single-case report leaves open need for prospective validation.
Thoracic combined spinal epidural anaesthesia offers the ideal perioperative anaesthesia and analgesia. A 78-year-old female presented to our hospital with a hypertensive emergency, non-ST elevation myocardial infarction and pulmonary effusion. Then the patient had abdominal pain, constipation and vomiting. When examined, there was significant abdominal distention. During a colonoscopy, there was a fungating mass lesion 20 cm from the anal verge. A biopsy was taken and showed intramucosal adenoma within tubulovillous adenoma with high-grade dysplasia. The patient underwent exploratory laparoscopy and laparotomy (sigmoidectomy, colostomy) under thoracic combined spinal epidural anaesthesia at T9-T10 interspinous space. The patient was classified as ASA5 according to the American Society of Anesthesiologists physical status. The guidelines recommend utilizing regional anaesthesia instead of general anaesthesia for compromised elderly patients. In our case, we report the first case in Palestine of an ASA5 patient who successfully underwent abdominal surgery under thoracic combined spinal epidural anaesthesia.
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Maree et al. (2024) conducted a case report in ASA5 patient requiring abdominal surgery (n=1). Thoracic combined spinal epidural anaesthesia was evaluated on Successful completion of surgery. Thoracic combined spinal epidural anaesthesia was successfully utilized for exploratory laparoscopy and laparotomy in a 78-year-old ASA5 patient.
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