Background and Aims Open cholecystectomy is a frequently performed procedure for symptomatic cholelithiasis in Sub-Saharan Africa due to lack of laparoscopic equipment or expertise. Although it has traditionally been performed under general anaesthesia in the developed world, general anaesthesia safety and access are particularly affected by resource gaps encountered in underdeveloped countries. Therefore, neuraxial anaesthesia is increasingly considered a safe, effective, and less resource-intense option in low-resource countries.
Methods The authors describe the successful use of neuraxial anaesthesia in a 48-year-old female patient proposed for urgent open cholecystectomy during a medical-humanitarian mission at the Simão Mendes National Hospital in Guinea-Bissau. Considering the local resource gaps, namely lack of access to functioning anaesthetic machines, basic airway equipment, capnography, neuromuscular function monitors, and even oxygen cylinders, regional anaesthesia was preferred rather than general anaesthesia. After informed consent, a combined spinal-epidural anaesthesia was performed using a separate needle technique with an initial subarachnoid injection of 3 ml of 0,5% levobupivacaine and 2.5 µg of sufentanil (T12-L1 level) followed by placement of an epidural catheter (T8-T9 level) for potentially prolonged surgery and postoperative multimodal analgesia. Ketamine and midazolam were given perioperatively for analgesia and anxiolysis, respectively. The patient remained conscious, on spontaneous ventilation, without the need for supplemental oxygen therapy or vasopressors.
General anaesthesia was successfully avoided The procedure was uneventful and postoperative recovery was unremarkable, with the patient being discharged within 24 hours.
Conclusions Neuraxial anaesthesia may be a safe, effective, and less expensive approach for urgent open cholecystectomy in Sub-Saharan Africa patients under similar circumstances.
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