Combined Spinal-Epidural Anaesthesia for Caesarean Delivery in a Parturient With Advanced Cystic Fibrosis and Acute Hypoxaemic Respiratory Failure: A Case Report

Pregnancy in patients with advanced cystic fibrosis (CF) presents significant challenges due to the risk of respiratory deterioration, pulmonary exacerbations, and preterm delivery.Anaesthetic management requires careful consideration of maternal respiratory reserve and the risks associated with general anaesthesia and airway instrumentation.An 18-year-old primigravida with advanced CF and severe respiratory impairment was admitted at 33 weeks and 3 days of gestation for maternal and fetal surveillance.She subsequently developed a pulmonary exacerbation complicated by acute hypoxaemic respiratory failure, requiring intensive care admission, antimicrobial therapy, and high-flow nasal cannula (HFNC) support.At 34 weeks and 1 day, progressive preterm labour prompted an urgent caesarean delivery.Given the severity of her respiratory compromise, combined spinal-epidural (CSE) anaesthesia was selected to avoid general anaesthesia and tracheal intubation.The technique involved intrathecal hyperbaric bupivacaine and sufentanil, followed by epidural ropivacaine supplementation to achieve an adequate sensory block.HFNC support was maintained throughout the procedure, with no intraoperative respiratory deterioration or haemodynamic instability.The neonate had Apgar scores of 9, 9, and 9 at one, five, and ten minutes, respectively.Postoperatively, the patient returned to the intensive care unit for respiratory monitoring and support.Her oxygen requirements progressively decreased, and she was discharged on postoperative day seven without supplemental oxygen.This case illustrates the feasibility of CSE anaesthesia for urgent caesarean delivery in a parturient with advanced CF and acute hypoxaemic respiratory failure.Individualised anaesthetic planning, multidisciplinary coordination, continuation of HFNC support, and preparation for potential conversion to general anaesthesia were central to the perioperative strategy.Although a single case cannot establish the superiority of CSE over alternative techniques, it highlights the potential role of neuraxial anaesthesia in selected high-risk parturients with severe respiratory compromise.