title: Combined spinal epidural anesthesia during colon surgery in a high-risk patient: case report.
abstract: OBJECTIVE
  Combined spinal epidural anesthesia (CSEA) has advantages over single injection epidural or subarachnoid blockades. The objective of this report was to present a case in which segmental subarachnoid block can be an effective technique for gastrointestinal surgery with spontaneous respiration.
  
  
  METHODS
  Patient with physical status ASA III, with diabetes mellitus type II, hypertension, and chronic obstructive pulmonary disease was scheduled for resection of a right colon tumor. Combined spinal epidural block was performed in the T5-T6 space and 8 mg of 0.5% isobaric bupivacaine with 50 microg of morphine were injected in the subarachnoid space. The epidural catheter (20G) was introduced four centimeters in the cephalad direction. Sedation was achieved with fractionated doses of 1 mg of midazolam (total of 6 mg). A bolus of 25 mg of 0.5% bupivacaine was administered through the catheter two hours after the subarachnoid block. Vasopressors and atropine were not used.
  
  
  CONCLUSIONS
  This case provides evidence that segmental spinal block can be the anesthetic technique used in gastrointestinal surgeries with spontaneous respiration.
authors.affiliation: Hospital São Bernardo e da Casa de Saúde Santa Maria. dr.imbelloni@terra.com.br
authors.forename: Luiz Eduardo
authors.initials: LE
authors.lastname: Imbelloni
authors.forename: Marcos
authors.initials: M
authors.lastname: Fornasari
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Fialho
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D012307:Risk Factors