Background and Aims Sarcoidosis is a complex granulomatous disease, typically dominant in the lungs. Pulmonary sarcoidosis can be asymptomatic or result in end-stage, severe, and/or life-threatening disease. Respiratory failure is the most common cause of death. Pulmonary sarcoidosis patients presenting as an emergency are at considerable risk.The anesthetic management of such a patient presenting as undergoing emergency surgery is discussed, at a hospital, which does not have facility for postoperative ventilation.
Methods A 42-year-old male patient diagnosed with pulmonary sarcoidosis presented as an emergency with acute appendicitis. Open appendicectomy under combined spinal epidural anaesthesia was decided on. The patient was under corticosteroid therapy and had a history of previous anaesthetic procedures; general anaesthesia for lung biopsy followed by ICU admission and spinal anaesthesia for open inguinal hernia repair. Preoperative evaluation revealed impairment on cardiopulmonary function: decreased left ventricular function with EF 55% and mild restrictive ventilator defect. Chest-X ray exhibited bilateral hilar and paratracheal adenopathy and diffuse reticulonodular pattern. Routine monitors namely, non invasive blood pressure, pulse oximetry and electrocardiogram were attached. Spinal anaesthesia was performed at L(3)-L(4) interspace using 2,5 ml of 0.75% Ropivacaine and Fentanyl. An epidural catheter inserted at L(3)-L(2) interspace was to be activated if needed.
Results An effective sensory block till T6 developed within 10 min and surgery was completed without operative difficulty 60 min after spinal injection. No intraoperative pain was reported. The patient evaluated his satisfaction with the procedure as good.
Conclusions Our case demonstrates open appendicectomy under spinal anaesthesia to be safe in patients with high-risk respiratory disease.
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