Thoracic spinal anesthesia for laparoscopic peritoneal dialysis catheter placement in older high-risk end-stage...

Peritoneal dialysis (PD) catheter placement is considered a controversial procedure in patients with a history of abdominal surgeries or peritonitis. In these subjects, video laparoscopic (VLS)-assisted placement under general anesthesia (GA) is the gold standard procedure. However, older multimorbid patients are at high risk for complications in GA. In our opinion, thoracic spinal anesthesia (TSA) instead of GA could also be used in older multimorbid patients undergoing PD. Here, we report five cases of older multimorbid end-stage kidney disease (ESKD) patients aged 79.6 ± 3.5 years with a history of abdominal surgery or peritonitis needing renal replacement therapy. Overall comorbidity was high (Cumulative Illness Rating Scale (CIRS) comorbidity index 4.0 ± 1.2 and CIRS severity index 2.1 ± 0.5). We placed the PD catheter in these patients using the VLS-assisted placement under TSA. All subjects underwent TSA performed at the T9-T10 thoracic level, obtaining optimal pain control and no periprocedural side effects. This is the first attempt to utilize the TSA in PD catheter VLS placement in very old multimorbid patients. Further studies could be useful to confirm whether TSA can be successfully used in VLS-assisted PD catheter placement, especially in subjects ineligible for GA such as older frailty patients.