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Online ISSN 1827-1596
Meggiorin G. 1, Onali A. 1, Manduco G. 1, Coraddu M. 2
1 Azienda Ospedaliera G. Brotzu, Brotzu SMH, Ospedale di Rilievo Nazionale e di Alta Specializzazione - Cagliari, Unità Operativa di Anestesia I e Terapia Antalgica;
2 Azienda Ospedaliera G. Brotzu, Brotzu SMH, Ospedale di Rilievo Nazionale e di Alta Specializzazione - Cagliari, Unità Operativa di Neurochirurgia
The case is presented of an obese 42 year-old female patient, undergoing a second spinal cord decompression for a large dorsolumbar fibrous-scar mass, having a small-bore Montgomery tracheal stent (T-tube) on site. Stent replacement with a tracheotomy tube was impossible because of strong accretions hindering stent removal, as well as insertion of a suitable tracheal tube through the external stent branch, because of its very small lumen. So, general anaesthesia was not administered and surgery was performed under continuous epidural block, with light sedation, using two catheters introduced up and down the compression. Surgical and anaesthetic outcomes were optimal and confirm the effectiveness and safety of epidural anaesthesia for dorsolumbar spinal surgery, even in the obese patient. Moreover, with the continuous double-catheter technique it was possible to achieve a good and homogeneous spread of the analgesic solution, with low volume, despite the hard compression and deformation of the epidural space due to the fibrous-scar mass.