Key result
Segmental spinal anesthesia allowed for a smooth and uneventful laparoscopic cholecystectomy in a patient with a history of pneumonectomy who was at high risk for general anesthesia.
Case Report (n=1)
No
Segmental spinal anesthesia can be a successful and safe alternative to general anesthesia for laparoscopic cholecystectomy in patients with severe cardiopulmonary comorbidities such as prior pneumonectomy.
Does not support practice change; leaves open the role of segmental spinal anesthesia in high-risk post-pneumonectomy patients.
Seventy-one years old, ASA physical status III, male patient underwent laparoscopic cholecystectomy due to acute cholecystitis with gall bladder (GB stone). He had undergone right pneumonectomy nine years ago. Moderate obstructive and restrictive pattern was found on PFT and hypokinesia of apical anterior and septum segments was seen on echocardiography. Due to patient's refusal of receiving general anesthesia, we decided to perform regional anesthesia. Epidural catheter was inserted at 10th thoracic intervertebral space and segmental spinal anesthesia was performed at L2-L3 intervertebral space with 5 mg of hyperbaric bupivacaine 0.5% and 20 ug of fentanyl. A segmental sensory block, extending from T3 through L2 dermatomes, was obtained. Surgery was performed smoothly and uneventfully. Patient discharged from hospital at 3 days after surgery.
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Yi et al. (2009) conducted a case report in Acute cholecystitis with gall bladder stone and history of right pneumonectomy (n=1). Segmental spinal anesthesia was evaluated on Successful completion of surgery and postoperative recovery. Segmental spinal anesthesia allowed for a smooth and uneventful laparoscopic cholecystectomy in a patient with a history of pneumonectomy who was at high risk for general anesthesia.
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