Continuous spinal anesthesia: A forgotten technique revisited in a high-risk patient

Abstract Although continuous spinal anesthesia (CSA) was introduced nearly a century ago, its clinical use remains limited due to concerns about safety and potential complications. However in carefully selected high-risk patients, CSA may provide a valuable alternative to general or epidural anesthesia. This article presents a clinical case involving a patient with severe pulmonary (tuberculosis complicated by hemoptysis, a significant history of smoking, chronic obstructive pulmonary disease (COPD), and severe pulmonary emphysema) and cardiovascular (stable angina and 70% stenosis of the left descending artery) comorbidities undergoing colostomy closure surgery. In this context, general anesthesia posed significant risks such as difficult airway management and the potential need for prolonged postoperative mechanical ventilation, while epidural anesthesia carried the risk of cardiovascular collapse. A review of relevant literature is also provided to highlight considerations for the safe implementation of CSA in similar contexts. Keywords: Continuous spinal anesthesia, high-risk patient, abdominal surgery. References Moore JM. Continuous spinal anesthesia. Am J Ther. 2009;16(4):289–294. Lemmon WT, Cohen EN, de Jong RH. Spinal anesthesia by continuous microinjection. Anesth Analg. 1944;23(6):287–291. Dripps RD, Vandam LD. Long-term follow-up of patients who received spinal anesthesia. JAMA. 1950;144(4):308–310. Lux EA. Continuous spinal anesthesia for lower limb surgery: a retrospective analysis of 1,212 cases. Local Reg Anesth. 2012;5:63–67. Standl T, Eckert S, Schulte AM, Esch J. Microcatheter continuous spinal anesthesia in the postoperative period: a prospective study of its effectiveness and complications. Eur J Anaesthesiol. 1995;12(3):273–279. Munhall RJ, O’Connor TZ. Reappraisal of spinal microcatheters: safety data from outside the United States. Anesth Analg. 2003;96(5):1392–1394. Peyton PJ. Complications of continuous spinal anesthesia. Anaesth Intensive Care. 1992;20(4):417–438. Reina MA, De Andrés JA, López A. Structural analysis of microcatheters in continuous spinal anesthesia. Rev Esp Anestesiol Reanim. 2006;53(6):361–366. Mahisekar UL, et al. Continuous spinal anesthesia and postdural puncture headache: a retrospective study. Reg Anesth. 1991;16(2):107–11 Download file PDF