3 ; 1 ; in Month : March (2021) Article No : sjtemac-v3-1008
Essam Abderazek, F Gardener

Abstract
Awake combined spinal epidural anaesthesia as the sole anaesthetic technique was successfully employed for an extended midline laparotomy for gynaecological cancer. The patient was a heavy smoker with chronic obstructive pulmonary disease. The procedure included total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy and right hemicolectomy. The nine hours surgery was tolerated very well and the CSE anaesthetic technique, which has been shown to reduce intra-operative and post-operative respiratory complications, may have significantly contributed to the prompt, complication free recovery experienced by the patient and her early discharge from the hospital. We report a case of awake major abdominal surgery removing a very large complex ovarian metastatic carcinoma causing bilateral basal lung atelectasis in a high-risk heavy smoker (30 to 60 cigarettes/day/50 years) 70 year old patient with chronic obstructive pulmonary disease (COPD), performed effectively under combined spinal epidural anaesthesia as a sole technique. Reviewing the literature, no similar cases have been reported before.

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