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Combined spinal epidural (CSE) is a regional anesthesia technique that combines the rapid onset of spinal anesthesia with the flexibility and prolonged analgesia of epidural anesthesia, making it a valuable option for major surgery in elderly patients with comorbidities. We report a case of a 76-year-old man with ASA physical status III diagnosed with multiple nephrolithiasis accompanied by bilateral hydronephrosis, who underwent open right nephrolithotomy under CSE anesthesia. The patient had a history of hypertension and mild renal function impairment, placing him at increased perioperative risk. Intraoperatively, hemodynamic parameters remained stable without significant hypotension, vasopressor requirement, or conversion to general anesthesia. Estimated blood loss was approximately 500 mL and was managed with crystalloid replacement without transfusion. Prophylactic antibiotic and adjuvant medications were administered according to surgical standards. Postoperatively, the patient was monitored in the ICU with stable vital signs and adequate pain control achieved through continuous epidural analgesia. This case highlights that CSE can be a safe and effective anesthetic approach for open nephrolithotomy in selected high-risk geriatric patients, providing satisfactory hemodynamic stability and postoperative recovery.

Hypotension following spinal anesthesia is a frequent perioperative complication, particularly among pregnant patients, with an incidence ranging from 60% to 80%. This condition may compromise uteroplacental perfusion and pose serious risks to both mother and fetus. Leg elevation represents a simple, safe, inexpensive, and effective non-pharmacological intervention that functions through gravitational autotransfusion, enhancing venous return and improving cardiac output. This scoping review was conducted using the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR framework, guided by the PICO approach. The population included adult patients undergoing spinal anesthesia, with the intervention consisting of elevating the legs at an angle of 20–30° or approximately 30 cm for 10–15 minutes, compared with the standard supine position. Literature searches were performed through PubMed  and Google Scholar, focusing on primary studies published within the last five years. Of the 130 articles identified, 10 met the inclusion criteria and were analyzed descriptively. The findings demonstrate that leg elevation significantly increases systolic and diastolic blood pressure as well as mean arterial pressure (MAP), while reducing the incidence of post-spinal hypotension. The technique also decreases vasopressor requirements without notable adverse effects, particularly in obstetric populations. Based on the available evidence, leg elevation is recommended as an effective and feasible initial non-pharmacological strategy for preventing hypotension after spinal anesthesia, especially in resource-limited clinical settings, with an optimal elevation of 20–30° for 10–15 minutes.

Perioperative anesthesia management is divided into preoperative preparation, intraoperative services (during the operation), and postoperative services. Preoperative anesthetic management is the first step in a series of anesthetic procedures carried out on patients who are planned to undergo surgery. Intraoperative anesthesia management is carried out by pre-induction, induction and maintenance assessments. Postoperative anesthetic management consists of discontinuing the anesthetic drug and stabilizing the patient.

Background: Spinal anesthesia is a procedure that involves administering drugs through the lumbar interspinous gap into the subarachnoid space. Hypothermia, a condition in which the body's core temperature drops below 36°C, carries a higher risk in the elderly and can cause serious perioperative complications. Body Mass Index (BMI) is an important parameter used to assess nutritional status, closely related to obesity and body fat mass, and can influence the body's response to anesthesia. Objective: This study aims to identify the relationship between hypothermia and age and BMI in post-spinal anesthesia patients at RSI Muhammadiyah Tegal. Method: This observational research with a cross-sectional design involved 73 samples selected through purposive sampling, with data analyzed using the Spearman Rank test to test the correlation between variables. Results: Most respondents were aged 19-44 (60.3%) and female (71.2%). As many as 58.9% of respondents experienced mild hypothermia, and 49,3% had normal BMI (18.5-25.5). The Spearman Rank test results showed a significant relationship between hypothermia and age and BMI after spinal anesthesia (p=0.008, P<0.05). Conclusion: There is a substantial association between hypothermia and age and BMI post-spinal anesthesia, indicating the importance of monitoring these factors perioperatively to reduce the risk of possible complications