title: Combined spinal-epidural anesthesia for radical hysterectomy in a patient with Sjȍgren syndrome with progressive interstitial lung disease.
abstract: BACKGROUND
  Interstitial lung disease (ILD), which is the most common form of respiratory involvement of Sjȍgren syndrome (SS), is highly associated with postoperative pulmonary complications after surgery. We report the successful anesthetic management of a cervical cancer patient with SS and ILD under combined spinal-epidural anesthesia (CSE) to avoid postoperative pulmonary complications.
  
  
  METHODS
  A 41-year-old woman with SS complicated by recently progressive ILD was scheduled for an elective radical hysterectomy under the diagnosis of cervical cancer. We performed CSE with separate needle technique (SNT) using two different interspaces. An epidural catheter was inserted at T11-T12 before administration of spinal medication at L3-L4. We could achieve successful anesthetic management for radical hysterectomy, maintaining stable hemodynamic variables. Postoperative analgesia, using epidural catheter, was effective and devoid of any postoperative pulmonary morbidity.
  
  
  RESULTS
  CSE could offer a high level of sensory blockade, profound muscular blockade, longer duration of surgical anesthesia, excellent postoperative pain control, and reduction in the incidence of pulmonary morbidity. Therefore it would be excellent anesthetic option for the patients with pulmonary impairment.
  
  
  CONCLUSIONS
  CSE with SNT may be particularly advantageous in patients with pulmonary impairment such as progressive ILD when general anesthesia is associated with high risk of postoperative complications.
authors: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea.
authors: Jeong-Min
authors: JM
authors: Hong
authors: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea.
authors: Eunsoo
authors: E
authors: Kim
authors: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea.
authors: Hae-Kyu
authors: HK
authors: Kim
authors: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea.
authors: Do-Won
authors: DW
authors: Lee
authors: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea ; Biomed Research Institute, Pusan National University Hospital, Busan, Korea.
authors: Ji-Seok
authors: JS
authors: Baik
authors: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea.
authors: Ji-Youn
authors: JY
authors: Lee
keywords: Combined spinal–epidural anesthesia; Interstitial lung disease; Radical hysterectomy; Sjȍgren syndrome