ArticlePatient safety in surgery2025
Awake sigmoidectomy under continuous spinal anesthesia in a high-risk ASA class V patient: a case report.
Article in Patient safety in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundAwake colorectal surgery is an alternative to general anesthesia, especially in high-risk patients with significant cardiopulmonary comorbidities. Continuous segmental spinal anesthesia offers stable intraoperative conditions while avoiding the complications of cardio depressant effects, airway manipulation and sedation. Despite its advantages, this approach remains underreported in major colorectal procedures. CASE PRESENTATION: We present the case of a 73-year-old male with a history of ischemic cardiomyopathy, chronic heart failure (ejection fraction 25-30%), chronic kidney disease, and pulmonary complications, classified as American Society of Anesthesiologists (ASA) Risk Class V. The patient was admitted to a tertiary hospital in Palestine with a recurrent sigmoid volvulus, and due to the high risk associated with general anesthesia, the surgical, cardiology and anesthesia teams decided for an awake open sigmoidectomy under continuous segmental spinal anesthesia. The patient remained fully conscious and hemodynamically stable throughout the procedure. Postoperative recovery was uncomplicated apart from a superficial wound infection, which was managed conservatively. At six-month follow-up, the patient remained asymptomatic, tolerated a normal diet, had no recurrent bowel obstruction, and showed complete wound healing without late infectious or anastomotic complications.
conclusionThis case illustrates the feasibility, safety, and potential benefits of awake sigmoidectomy in fragile, multimorbid patients. To our knowledge, it represents the first reported case in Palestine. The successful outcome emphasizes the importance of advanced regional techniques and multidisciplinary collaboration in managing high-risk surgical patients, especially in settings with limited resources.
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