An elderly patient was listed for laparoscopic sigmoid colectomy After spinal anaesthesia was administered, the patient became profoundly hypotensive, and CPR was undertaken for a short period before induction of general anaesthesia. The surgical team were not informed of this episode at the time, and it was felt that the opportunity to discuss whether to continue with surgery had been missed, given the potential complications of chest compressions in a frail elderly patient with co-morbidities.

Commentary:

Spinal anaesthesia has great value in improving pain management after major surgery and is now carried out routinely.  There is an increased risk of cardiovascular collapse following spinal anaesthesia in patients with multiple co-morbidities.  This may occur due to the synergistic effect of spinal and general anaesthesia or can occur prior to induction.  Invasive monitoring and prophylactic infusion of vasopressors should be considered, as well as reducing the dose of local anaesthetic administered intrathecally.  Where a major complication of anaesthesia has occurred, the theatre team should be informed so that a multi-disciplinary decision can be made as to whether it is in the patients’ best interest to continue with the operation as planned.