Low-dose combined spinal-epidural anaesthesia for caesarean section in a patient with Eisenmenger's syndrome

A 34-year-old woman (G3,P0) with Eisenmenger's syndrome and positive HIV serology presented to hospital at 16 weeks of pregnancy. She was hospitalised at 20 weeks under the care of a multidisciplinary team. At 33 weeks caesarean section was performed under low-dose combined spinal-epidural anaesthesia using a needle-through-needle technique. Over a period of 10 min, spinal anaesthesia produced a sensory block to T4 which did not alter oxygenation or blood pressure. Epidural supplementation was not required. The caesarean section proceeded uneventfully without pain or discomfort. The post-partum period was without major incident. Low-dose combined spinal-epidural techniques combine the advantages of spinal and epidural blockade; the versatility allows its use in a wide range of clinical conditions, combining effective anaesthesia with cardiovascular stability.