Combined spinal epidural anesthesia for an unusually prolonged caesarean section in a morbidly obese patient

We present a case report of elective Caesarian section of a morbidly obese parturient under combined spinal epidural [CSE] technique, which, somehow, lasted for more than five hours. The patient remained awake of her own desire and she refused conversion to general anesthesia. The course of anesthesia required careful titration of the local analgesic solutions, well beyond the usual admissible total doses, and maintenance of her hemodynamic parameters