Awake emergency laparotomy under combined spinal epidural anaesthesia in a high-risk patient with severe pulmonary disease and neuromuscular blocking agent anaphylaxis.
Shikshya Khatiwoda, Satya Durga Anantapatnaikuni
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Case in brief
A frail elderly patient with severe chronic obstructive pulmonary disease and anaphylaxis to multiple neuromuscular blocking agents underwent an awake emergency laparotomy using combined spinal-epidural anaesthesia. The procedure was successfully completed without the need for general anaesthesia, and the patient experienced an uncomplicated perioperative course with no respiratory issues.
Diagnostic / clinical pearl
This case demonstrates that combined spinal-epidural anaesthesia can be a viable alternative to general anaesthesia in high-risk patients with known allergies to neuromuscular blocking agents.
Why it matters
The successful use of neuraxial anaesthesia in this context emphasizes the need for careful anaesthetic planning and multidisciplinary collaboration in managing complex surgical cases.