Combined Sequential Spinal Epidural Anaesthesia in Geriatric with a STOP BANG Score of 6 for Total Knee Replacement Surgery - The Anaesthesiologist Plight

Background: Sequential combined spinal epidural anaesthesia (Sequential CSEA) is probably the greatest advance in central neuraxial block. Sequential combined spinal epidural anaesthesia is a safe, effective, reliable technique with stable haemodynamic along with provision of prolonging analgesia compared to spinal anaesthesia alone for high risk geriatric patients undergoing major orthopaedic surgery. Studies reveal that spinal anaesthesia combined with epidural technique has been shown to ameliorate the hyperglycemic as well as catecholamine surge to surgery1. We report a case of 65 year old obese patient with STOP BANG score of 6 with multiple comorbidities for Total knee replacement (TKR) under combined sequential spinal epidural anaesthesia with stable hemodynamics. To reduce the incidence and severity of hypotension a sequential combined spinal epidural technique has been described earlier in obstetric practice in which a spinal dose of local anaesthetic intended to be inadequate for surgery is used in an attempt to reduce hypotension but then the block is deliberately extended cephalad with the epidural drug.