OPEN CHOLECYSTECTOMY UNDER THORACIC ANESTHESIA IN A PATIENT WHO HAS CHRONIC OPSTRACTIVE PULMONARY DISEASE WITH HEART FAILURE AND DEVELOPED RESPIRATORY DISTRESS-A CASE REPORT

Abstract

For decades, the management of symptomatic cholelithiasis in high surgical risk patients has remained contentious. Cholecystectomy has become firmly established as a procedure of choice in the management of symptomatic cholelithiasis. The procedure usually necessitates general anesthesia and endotracheal intubation to prevent aspiration and respiratory embarrassment secondary to the induction of pneumoperitoneum. Open cholecystectomy (OC) usually necessitates general anesthesia and endotracheal intubation to prevent aspiration and respiratory embarrassment. We report our preliminary experience with open cholecystectomy using thoracic anesthesia in patients with cardiac failure and with previous history of smoking. A 78-year-old mal (weight 81 kg, height 176 cm) with abdominal pain applied to the emergency department. After general surgery and infectious disease consultations, he was admitted to the intensive care unit because of high infection parameters and general condition disorder. He had a history of frequent pain at the right hypochondriac region with ultrasonography documented calculi in the gallbladder for two years and heart failure. With the patient at the right lateral decubitus position, EA was performed with a 18-G thoracic catheter inserted 4cm towards the cephalad-direction from T7/T8 successfully. After completion of the surgical procedure, the thoracic catheter was removed, and the patient was shifted to the post-anesthesia care unit (PACU) for further observation. The patient remained hemodynamically stable and comfortable during the 1 hour at PACU. In this case report, we wanted to demonstrate the management of an emergency case with epidemic anesthesia, with a general condition of poor heart failure and septic shock.