{
  "abstract": "Background and Aims Patients with severe pulmonary comorbidities present significant anesthetic challenges, especially when urgent surgical intervention is needed. This case illustrates the use of regional anesthesia as a safer alternative to general anesthesia in a patient at high risk for respiratory compromise.Methods A 76-year-old woman with severe COPD and a recent history of postop complications from shoulder replacement (2 months ago)—bilateral pneumothoraces, pulmonary embolism, and bilateral basal consolidation—underwent urgent shoulder washout with exchange of liner and metalwork. Her initial postoperative course was prolonged, including an extended ICU stay and persistent respiratory compromise. Given the high risk associated with GA, a regional approach was selected. An US-guided interscalene brachial plexus block was performed under light sedation. This technique was chosen to provide effective anaesthesia while minimizing the risk of diaphragmatic paralysis and further respiratory decline by using appropriate volume for the block. Intraoperative management focused on maintaining spontaneous respiration, minimizing sedative use, and closely monitoring oxygenation and respiratory effort. The regional technique allowed the procedure to be completed safely in a high-risk patient with critical respiratory vulnerability.Results The surgical procedure was completed successfully without conversion to GA or airway instrumentation. The patient maintained spontaneous ventilation throughout, experienced no respiratory deterioration, and avoided postoperative ICU admission. Her recovery was uncomplicated, with stable pulmonary function and no additional respiratory interventions required.Conclusions This case highlights the value of regional anaesthesia with light sedation in patients with significant pulmonary compromise. Avoiding airway manipulation and mechanical ventilation can substantially reduce the risk of perioperative respiratory complications. Optimal outcomes in high-risk patients require individualized anaesthetic planning, thorough patient counseling and informed consent, and close multidisciplinary coordination. Involvement of an experienced consultant surgeon to minimize operative time further contributes to patient safety. The decision between regional and GA and the choice of agents remain critical.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesia, Walsall Manor Hospital, Derby, UK"
      ],
      "name": "Avinash Manekar"
    }
  ],
  "title": "P245 Awake shoulder surgery in a high-risk patient with multiple respiratory problems using interscalene brachial plexus block and sedation: a case report",
  "uid": "90d79ceb-65aa-5861-8456-4dcb32c75a2b"
}