Combined Spinal-Epidural Anaesthesia for Urgent Caesarean Delivery in Advanced Cystic Fibrosis With Acute Respiratory Failure
An 18-year-old pregnant woman with advanced cystic fibrosis and acute hypoxaemic respiratory failure underwent urgent caesarean delivery under combined spinal-epidural anaesthesia while maintaining high-flow nasal cannula support, Cureus reported on November 8, 2026.
- Combined spinal-epidural anaesthesia successfully avoided general anaesthesia and endotracheal intubation in a high-risk parturient with severe pulmonary impairment.
- High-flow nasal cannula oxygen support was maintained continuously throughout the intraoperative period without causing respiratory deterioration.
- The patient was discharged on postoperative day seven without supplemental oxygen following intensive care unit monitoring.
Pregnancy in patients with advanced cystic fibrosis creates severe clinical challenges driven by progressive pulmonary disease and diminishing respiratory reserve. Cureus noted that the physiological demands of gestation increase the risks of respiratory exacerbations, hospital admissions, and preterm delivery.
The patient in this case study was admitted at 33 weeks and 3 days of gestation for maternal and fetal surveillance, presenting with chronic airway infection and homozygosity for the F508del variant. During her pregnancy course, she experienced multiple pulmonary infections requiring antimicrobial regimens and suffered a spontaneous right-sided pneumothorax.
Clinical deterioration occurred on day four after initial presentation as she presented with dyspnoea on minimal exertion and uterine contractions. Arterial blood gas analysis under a Venturi mask at an FiO₂ of 0.40 revealed a partial pressure of arterial oxygen of 69 mmHg and a PaO₂/FiO₂ ratio of approximately 173 mmHg.
Cureus reported that chest radiography confirmed worsening infiltrates across the right lower lobe and the posterior segment of the right upper lobe. As oxygen demands escalated, clinicians initiated high-flow nasal cannula therapy at 45 L/min, which required upward titration to an FiO₂ of 0.75 to maintain peripheral oxygen saturation above 90%. Progression of preterm labour at 34 weeks and 1 day prompted the multidisciplinary team to schedule an urgent caesarean delivery.
General anaesthesia carries heightened risks for parturients with compromised pulmonary function due to airway instrumentation. Cureus stated that the medical team selected combined spinal-epidural anaesthesia to bypass these risks and preserve spontaneous breathing. The technique utilized intrathecal hyperbaric bupivacaine and sufentanil, supplemented by epidural ropivacaine to establish an adequate sensory block.
High-flow nasal cannula support remained active throughout the surgical procedure, preventing intraoperative respiratory decline or haemodynamic instability. The neonate delivered under this protocol achieved Apgar scores of 9, 9, and 9 at one, five, and ten minutes.
Following the delivery, the patient transferred back to the intensive care unit for targeted respiratory monitoring. Cureus reported that her supplemental oxygen requirements steadily declined over the postoperative period. She achieved successful liberation from oxygen support and left the hospital on postoperative day seven.
This clinical record shows that neuraxial techniques work for high-risk obstetric patients experiencing acute hypoxaemic respiratory failure, though researchers emphasize that individualised perioperative planning and readiness for emergency airway conversion are vital components of care. This case was previously presented as a poster at Euroanaesthesia 2026 in Rotterdam from June 6 to 8, 2026.
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