Management of a centenarian who underwent emergency laparoscopic cholecystectomy under general anesthesia with subcostal transversus abdominis plane block.

Yoshiyuki Nagamine,Kohei Godai,Hiroshi Oki,Yuichi Kanmura

doi:10.1186/s40981-016-0050-9

Abstract

The anesthetic management of centenarians is challenging, since they have loss of functional reserve in all organs. The mortality rate of 25 % is reported in patients over 100 years old who underwent emergency surgery. The transversus abdominis plane block has been shown to provide effective analgesia in laparoscopic cholecystectomy. A 101-year-old woman was diagnosed with grade I (mild) acute cholecystitis with gallstones. An emergency laparoscopic cholecystectomy was scheduled. The patient had a history of hypertension. The patient’s laboratory data showed that she had mild coagulopathy, anemia, thrombocytopenia, and decreased renal function. After induction of general anesthesia, an ultrasound-guided, bilateral subcostal transversus abdominis plane block was performed. Her postoperative course was uneventful. Using the preoperative subcostal transversus abdominis plane block, we were able to avoid hemodynamic instability and to reduce opioid dosage in a centenarian who underwent emergency laparoscopic cholecystectomy under general anesthesia.

Highlights

The incidence of gallstones is known to increase with age [1]
Intraoperative and postoperative analgesia in patients undergoing Laparoscopic cholecystectomy (LC) can be achieved with intravenous opioid or thoracic epidural analgesia, there are concerns about opioid-related side effects and hemodynamic instability in the elderly patients [5]
We here report an anesthetic management of a centenarian patient who underwent LC using transversus abdominis plane block (TAPB)

Summary

Background

The incidence of gallstones is known to increase with age [1]. Laparoscopic cholecystectomy (LC) is reported to be safe and feasible in patients older than 80 years [2]. Case presentation A 101-year-old woman (145 cm, 45.2 kg) was diagnosed with grade I (mild) acute cholecystitis with gallstones She had a 2-day history of right upper abdominal quadrant pain, Murphy’s sign was not seen. Elevated white blood cell count (>18,000/ mm3), palpable tender mass in the right upper abdominal quadrant, duration of complaints >72 h, and marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis) are considered as signs of grade II (moderate) acute cholecystitis [7]. She was able to walk with a cane without help. The patient was discharged from the hospital on postoperative day 6

Discussion

Conclusions