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Background and Aims Rapid sequence spinal anesthesia for emergent cesarean delivery remains a controversial technique in patients with relative contraindications such as systemic infection.

Methods A 20-year-old woman at 41 weeks of gestation was admitted due to severe labour pain and early decelerations on CTG. The patient requested epidural analgesia, which was contraindicated due to prolonged rupture of membranes and elevated inflammatory markers (leukocytes: 25000/mL, CRP: 30 mg/dL) on admission. After starting antibiotic therapy, a remifentanil perfusion was started under clinical and instrumental monitorization and titrated to 0.15 mcg/kg/min, according to institutional protocol, providing effective pain relief and stable vital signs. An hour after admission, the patient developed a placenta abrupta. She was swiftly transported to the operating theatre, where a rapid sequence spinal anesthesia was performed, providing adequate anesthesia and a timely completion of the caesarean delivery.

Results The child was born healthy and the patient developed no neurological complications after the procedure.

Conclusions Rapid sequence spinal anesthesia may contribute to reducing the decision-to-delivery interval in patients without an epidural catheter, leading to favourable outcomes for both the mother and the neonate in challenging clinical situations. Further studies should investigate whether single puncture neuraxial techniques require antibiotic pretreatment for infection and for how long.