Continuous Spinal Anaesthesia (CSA) for Emergency Laparotomy in High-Risk Elderly patients: Technique and Outcomes of a Prospective Service Evaluation

Abstract

Continuous Spinal Anaesthesia is a recognized technique for providing anaesthesia for various surgical procedures. It may be an alternative to general anaesthesia in high-risk elderly patients requiring emergency laparotomy. The objective was to evaluate the benefits of continuous spinal anaesthesia in providing effective anaesthesia for emergency laparotomy, in enhancing recovery after major abdominal surgery and in reducing length of stay in the intensive care unit in high-risk elderly patients. Prospective service evaluation was performed at a tertiary care university hospital. High-risk elderly patients were offered both general anaesthesia and continuous spinal anaesthesia. An 18-gauge macro catheter was inserted into the intrathecal space through a 16-gauge Tuohy needle. Sedation was maintained with remifentanil. Prophylactic anti-emetics were administered. Blood pressure was maintained with an infusion of metaraminol. Over a 27-month period, 25 high risk elderly patients were offered continuous spinal anaesthesia and general anaesthesia for emergency laparotomy. Twenty-one patients opted for continuous spinal anaesthesia. Three patients required conversion to general anaesthesia. In the remaining 18 patients, continuous spinal anaesthesia provided adequate anaesthesia for major bowel surgery. Mean length of stay in level 2 care was 1.6 days. 30-day mortality was 14%. None of the patients reported post dural puncture headache. There were no neurological complications. Emergency laparotomy carries well-recognised intra and postoperative risks and in the elderly cohort, these risks are significant and probably life threatening. Continuous spinal anaesthesia is a well-established technique that may offer some reduction of both intra and postoperative risks with an improved immediate recovery from major emergency surgery.