{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:10:03Z","timestamp":1786119003234,"version":"build-2736575974"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T00:00:00Z","timestamp":1715040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and importance:<\/jats:title>\n                    <jats:p>Routine general anesthesia with tracheal intubation is an undesirable and risky technique in individuals with pre-existing chronic respiratory diseases undergoing abdominal surgery. Instead, other modalities of regional anesthesia, such as combined thoracic spinal -epidural anesthesia, could be used as the only anesthetic technique with more excellent health care outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>We introduce a 72-year-old morbidly obese female with multiple comorbidities who underwent successful open surgical repair for incarcerated abdominal hernia under awake combined thoracic spinal -epidural anesthesia. The procedure proceeded smoothly without any cardio-pulmonary complications. The patient was then admitted to the Surgical Intensive Care Unit for close monitoring. Six days later, she was discharged home with good general status without any complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>Superior results are reported for combined thoracic spinal -epidural anesthesia over GA in reducing postoperative respiratory events and enhancing outcomes by blunting the stress response. In particular, in challenging airways, combined thoracic spinal -epidural anesthesia offers various benefits, one of which is reducing airway handling. Hemodynamic stability is another frequently mentioned feature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Patients with high-risk conditions are a big challenge for anesthesiologists. The standard practice of general anesthesia should be avoided in this group of patients, as it exposes them to many threats. In this report, we highly advocate using regional anesthesia in this group of patients. This type of anesthesia significantly decreases intra and post-operative anesthetic complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.109744","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T11:45:34Z","timestamp":1715168734000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Classic incisional hernia repair under awake thoracic combined spinal -epidural anesthesia in a geriatric patient with multiple co-morbidities"],"prefix":"10.1097","volume":"119","author":[{"given":"Mariam","family":"Thalji","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Al-Quds University, Jerusalem, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawan","family":"Tarayrah","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care unite, Al-Ahli Hospital, Hebron, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Ruzaygat","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care unite, Al-Ahli Hospital, Hebron, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diya","family":"Motawe","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care unite, Al-Ahli Hospital, Hebron, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falah","family":"Ibedo","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care unite, Al-Ahli Hospital, Hebron, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"1","key":"R1-84-20260422","first-page":"16","article-title":"Thoracic epidural anaesthesia and analgesia","volume":"4","author":"McLeod","year":"2004","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain"},{"issue":"2","key":"R2-84-20260422","article-title":"Emergency awake abdominal surgery under thoracic epidural anaesthesia in a high-risk patient within a resource-limited setting","volume":"15","author":"Le Roux","year":"2023","journal-title":"Cureus"},{"issue":"2","key":"R3-84-20260422","doi-asserted-by":"crossref","first-page":"236","DOI":"10.4103\/0259-1162.108352","article-title":"Segmental thoracic spinal anesthesia in patient with byssinosis undergoing nephrectomy","volume":"6","author":"Patel","year":"2012","journal-title":"Anesth. Essays Res."},{"issue":"6","key":"R4-84-20260422","article-title":"Thoracic epidural anesthesia for modified radical mastectomy in a high-risk patient: a case report with literature review","volume":"13","author":"Srivastava","year":"2021","journal-title":"Cureus"},{"issue":"5","key":"R5-84-20260422","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi","year":"2023","journal-title":"Int. J. Surg. Lond. Engl."},{"issue":"5","key":"R6-84-20260422","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1097\/AAP.0000000000000641","article-title":"Perioperative breast analgesia: a qualitative review of anatomy and regional techniques","volume":"42","author":"Woodworth","year":"2017","journal-title":"Reg. Anesth. Pain Med."},{"issue":"2","key":"R7-84-20260422","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/ALN.0b013e318224cc5c","article-title":"Epidural analgesia is associated with improved health outcomes of surgical patients with chronic obstructive pulmonary disease","volume":"115","author":"van Lier","year":"2011","journal-title":"Anesthesiology"},{"issue":"4","key":"R8-84-20260422","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.bjae.2018.12.002","article-title":"Management of the patient presenting for emergency laparotomy","volume":"19","author":"Ilyas","year":"2019","journal-title":"BJA Educ."},{"issue":"1","key":"R9-84-20260422","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/aas.13461","article-title":"The association between epidural analgesia and mortality in emergency abdominal surgery: a population-based cohort study","volume":"64","author":"Vester-Andersen","year":"2020","journal-title":"Acta Anaesthesiol. Scand."},{"issue":"10","key":"R10-84-20260422","article-title":"Thoracic segmental spinal anesthesia for emergency cholecystectomy: a case report","volume":"14","author":"Aljuba","year":"2022","journal-title":"Cureus"},{"issue":"2","key":"R11-84-20260422","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.bpa.2018.06.010","article-title":"New local anesthetics","volume":"32","author":"Shah","year":"2018","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"issue":"6","key":"R12-84-20260422","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1016\/j.jopan.2018.09.005","article-title":"Local anesthetic systemic toxicity: reviewing updates from the American Society of Regional Anesthesia and Pain Medicine practice advisory","volume":"33","author":"Wolfe","year":"2018","journal-title":"J. Perianesth. Nurs."},{"issue":"3","key":"R13-84-20260422","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s12630-016-0797-5","article-title":"L-carnitine reduces susceptibility to bupivacaine-induced cardiotoxicity: an experimental study in rats","volume":"64","author":"Wong","year":"2017","journal-title":"Can. J. Anaesth."}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S221026122400525X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S221026122400525X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ovid.com\/10.1016\/j.ijscr.2024.109744","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T17:11:08Z","timestamp":1786036268000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1016\/j.ijscr.2024.109744"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":13,"journal-issue":{"issue":"C","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1016\/j.ijscr.2024.109744","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"print"}],"subject":[],"published":{"date-parts":[[2024,6]]},"assertion":[{"value":"2024-03-28","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-07","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}