Exploratory Laparotomy With Enhanced Recovery Under Combined Thoracic Segmental Spinal and Epidural Anesthesia in a High-Risk Elderly Patient: A Case Report

Abstract

Incisional hernia after an abdominal surgery may be complicated by small bowel obstruction (SBO), which needs prompt surgical intervention, commonly under general anesthesia (GA). Elderly patients with comorbidities are at high risk for anesthesia. Thoracic segmental spinal anesthesia (TSSA) is a feasible alternative in such high-risk cases where extended anesthesia duration may be achieved by combining epidural. We report the case of a 66-year-old obese female patient presenting with a three-day history of SBO with starvation ketosis and bilateral pleural effusion who underwent exploratory laparotomy under TSSA at T10 combined with epidural anesthesia at T11. The 4-hour procedure, involving 500 mL blood loss replaced with one unit of packed red blood cells, was successfully completed with stable vitals. The hypotension following TSSA responded to a bolus of 6 mg of ephedrine, and low-dose noradrenaline infusion was used to counteract further hemodynamic instability. The patient rema