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[Open cholecystectomy under thoracic epidural anesthesia in diffuse interstitial lung disease]
M Cortiñas Sáenz1, J Maria Jiménez Vizuete, F Vega Pérez
1Servicio de Anestesiología y Cuidados Críticos, Hospital General Universitario de Albacete. mcorti@teleline.es
Revista Espanola De Anestesiologia Y Reanimacion
|June 18, 2004
Summary
Thoracic epidural anesthesia provided satisfactory pain relief for two patients with severe lung fibrosis undergoing cholecystectomy. This anesthesia technique is a viable alternative to general anesthesia in high-risk patients.
Area of Science:
- Anesthesiology
- Pulmonology
- Gastroenterology
Background:
- Patients with diffuse pulmonary fibrosis present significant anesthetic challenges, particularly those requiring abdominal surgery.
- General anesthesia can exacerbate respiratory compromise in patients with advanced interstitial lung disease.
- Thoracic epidural anesthesia (TEA) offers potential benefits for pain control and respiratory function.
Observation:
- Two patients (73 and 58 years old) with diffuse pulmonary fibrosis underwent emergency subcostal cholecystectomy.
- Anesthesia was induced and maintained using thoracic epidural with 0.5% ropivacaine and fentanyl, allowing spontaneous ventilation.
- Both patients experienced transient arterial hypotension, managed effectively with low-dose norepinephrine infusion.
Findings:
- Thoracic epidural anesthesia was successfully employed in patients with advanced pulmonary fibrosis undergoing cholecystectomy.
- Hemodynamic stability was achieved post-anesthetic intervention, with no adverse events noted after sympathetic block reversal.
- Postoperative pain management with epidural analgesia was highly effective.
Implications:
- TEA is a safe and effective alternative to general anesthesia for subcostal cholecystectomy in patients with severe lung disease.
- This approach may improve perioperative outcomes by preserving respiratory function.
- Further research should explore TEA's role in other surgical procedures for patients with interstitial lung disease.