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.

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