Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Hemodynamic instability due to high block largely limits the use of conventional dose spinal anesthesia in high-risk septic patients.
Objectives: This work aimed to evaluate the efficacy and safety of continuous spinal anesthesia (CSA) and compare it with general anesthesia (GA) technique in sepsis-diagnosed patients.
Patients and methods: This prospective randomized single-blind comparative clinical study was carried out on 110 patients aged above 21 years old of both sexes, American Society of Anesthesiologist I, II and III diagnosed with sepsis, SOFA score up to 7, hemodynamically stable and not on vasopressor support. Patients were randomly allocated into two equal groups. Group I: received CSA via conventional epidural catheter and Group II: received GA.
Results: Compared to the GA group, the CSA group achieved significant hemodynamic stability during and after surgery with notably lower reported vasopressor dosages (p≤0.05). In GA group, there were 6 patients not extubated from mechanical ventilation (MV), while in the CSA group, no patients needed MV during    the surgery (p=0.027). Over 72h postoperatively, more patients needed MV in GA group (14.5%) versus (3.6%) in CSA (p=0.047). Additionally, at various research time intervals, the CSA group statistically outperformed the GA group in terms of maintained urine output, acid-base status, and lower mortality incidence.
 Conclusions: With superior hemodynamic stability, better acid-base balance, less need for vasopressors, postoperative mechanical ventilation, and a reduced mortality rate, CSA is safer than GA in patients with sepsis during the perioperative phase.