Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency
Authors Mehta N, Gupta S, Sharma A, Dar M
Received 11 April 2015
Accepted for publication 10 September 2015
Published 2 December 2015 Volume 2015:8 Pages 101—104
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Professor Visnja Nesek Adam
Peer reviewer comments 3
Editor who approved publication: Dr Stefan Wirz
Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar
Department of Anesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India
Abstract: Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency.
Keywords: geriatric anesthesia, bupivacaine, segmental anesthesia, laparoscopic surgery
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