Excision of spinal tumor in a patient with severe pulmonary dysfunction using combined spinal and epidural anesthesia with two epidural catheters

Background and Objectives. Combined spinal and epidural anesthesia (CSEA) h as become common practice. We performed CSEA using two epidural catheters i n a 69-year-old female with severe pulmonary dysfunction caused by a diaphr agmatic hernia, who underwent surgical excision of a lumbar spinal tumor. M ethods. Combined spinal and epidural anesthesia was performed using two epi dural catheters to minimize postoperative pulmonary complications. One epid ural catheter was inserted above the surgical region, at the T11-12 intersp ace, and another one below the surgical region, via the sacral hiatus. Spin al anesthesia was produced using the L5-81 interspace and 3 mt 0.5% bupivac aine. Oxygen, 3 L/min, was administered through a face mask during surgery. Results. Fifteen minutes after spinal anesthesia, analgesic level was conf irmed below T7 using the pinprick method. The patient complained of pain in the surgical region 10 minutes after the dura mater was opened. We injecte d 5 mt 2% mepivacaine through the upper epidural catheter to relieve the pa in. We also injected 10 mt 2% mepivacaine through the lower catheter when s he felt pain in the right leg. The perioperative course was uneventful. Oxy gen saturation was maintained above 95%. Conclusions. Combined spinal and e pidural anesthesia using two epidural catheters was used successfully to ex cise a spinal tumor in a patient with severe pulmonary dysfunction.