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55 Continuous spinal anesthesia for open cholecystectomy: customized anaesthetic management in a challenging patient
  1. C Lopes,
  2. D Zuzarte and
  3. M Correia
  1. Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal


Background and Aims Continuous spinal anesthesia (CSA) provides fast onset titratable neuroaxial block. In the context of upper abdominal surgery on patients with acute respiratory disease offers minimization of respiratory complications and ensures adequate anaesthetic conditions.

We aim to present a CSA for open cholecystectomy in a patient with multiple neurological deficits and acute pneumonia.

Methods 60 years-old woman, 40 kg, 152 cm. Past history of rickets having severe skeletal deformation; hypertension; status post cerebellar tumor resection with multiple sequelae: loss of visual and auditory acuity, dysphagia, dysphonia, respiratory insufficiency and ventriculoperitoneal shunt. Admitted for urgent open cholecystectomy having alongside acute pneumonia with pleural effusion. Laboratory tests and current medication posed no contraindication to spinal anesthesia.

Spinal catheter 20G was introduced through 18G tuohy needle at L3-L4 level. On supine position the adequate block level was achieved using bed tilting and sequential doses of hyperbaric bupivacaine (total of 10 mg) and sufentanil (total of 10 mcg). During the 1h procedure there was no need for sedation. The spinal catheter was removed on the operatory room (OR) after a morphine 100 mcg administration. Neither respiratory nor regional anesthesia complications were reported on the postoperative period.

Results Although a CSA in this patient was a challenge we considered that the benefits exceeded the risks and surpassed limitations of other techniques. The anaesthetic plan was sustained by careful communication with the patient and strict collaboration of the surgical team.

Conclusions CSA allowed a safe and effective management during the intraoperative period and optimized the postoperative recovery.

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