Combined spinal-epidural anaesthesia in a high-risk abdominoplasty - A case report

Abstract

Abdominoplasty is generally performed with admission of the patient for one night. It is a usual beautifying technique. It is reported that abdominoplasty can cause death and morbidity. For performing abdominoplasty numerous anaesthesia techniques are reported. Morbidly obese patients with compromised heart ailment undergoing abdominoplasty pose exceptional challenges to the anaesthesiologist. It is necessary to use the anaesthetic procedure such that it causes minimal haemodynamic instabilities with supreme safety for the patient. In this case report a 53-year-old male, morbidly obese patient with a body mass index (BMI) of 43.8 Kg/m, belonging to American Society of Anaesthesiologist (ASA) grade IV, and overhanging abdomen till the level of knee, with ventricular bigeminy, severe pulmonary hypertension, obstructive sleep apnea and chronic kidney disease is described. Abdominoplasty of this patient was performed under combined spinal-epidural anaesthesia. The implications of combined spinal-epidural anaesthesia were that the hemodynamic parameters such as heart rate, respiratory rate, non-invasive blood pressure, SpO2 were stable during the procedure and no complications were observed post-operatively. The results were excellent with speedy recovery.