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Background: There is evidence that surgery performed under general anesthesia supplemented with neuraxial
blockade by either intrathecal or epidural local anesthetic is associated with a reduced incidence of postoperative pulmonary morbidity when compared to general anesthesia alone. Conducting abdominal surgery under regional anesthesia in the absence of general anesthesia and endotracheal intubation has received little attention.
Case report: We performed combined spinal-epidural anesthesia for a patient with severe COPD undergoing
low anterior colorectal resection requiring mobilization of the splenic flexure. Using intrathecal (3.5 ml) and epidural isobaric bupivacaine 0.5% (6 ml) for intraoperative anesthesia followed by continuous epidural infusion
of bupivacaine 0.1% fentanyl for postoperative analgesia, this patient experienced no pulmonary complications and was discharged on the sixth day after surgery.
Conclusions: We present spinal-epidural anesthesia as an alternative anesthetic for patients undergoing major intraperitoneal procedures, in whom endotracheal intubation and positive pressure ventilation should be avoided.