Background and Aims Laparoscopic cholecystectomy (LC) is relatively common procedure which is generally performed under general anesthesia. However in some specific cases, regional anesthesia can be considered as a good choice for patients who are poor candidates for general anesthesia due to comorbidities. In this case we present laparoscopic cholecystectomy under spinal anesthesia successfully performed in patient with anesthetic problems include HFrEF and COPD
Methods A 68-year old, ASA III male patient underwent laparoscopic cholecystectomy. He had been diagnosed COPD, and heart failure with ACC/AHA stage III, NYHA score IIIa. He is former smoker and overweighed. He had coronary revascularization 10 years ago. In echocardiography septal hypokinesia, left ventricle dilation with 3,8*1,6 cm thrombus in anterior wall of left ventricle. EF was 33%. On ECG heart rate was 78 bpm with Q wave and negative T wave on V3-V6 leads. Cardiology consultation reported a postoperative risk of 7% based on modified Goldman cardiac risk criteria.
Results Upon arrival at the operating room routine monitoring was established. Patient sat upright position and 27G spinal needle was used to enter the subarachnoid space at the T10-T11 intervertebral space under complete aseptic technique. Hyperbaric bupivacaine 0.5% 2 ml, 0.005% 0.4 ml was injected so that a sensory loss up to T3 dermatome was achieved. LC was smooth and uneventful
Conclusions Patients with very low EF% are considered to be high risk for general anesthesia due to irregular heartbeat. Spinal anesthesia can be safe anesthetic method to be used in patient with advanced cardiopulmonary disease by experienced and qualified anesthesiology team.
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