title: Regional anesthesia as an alternative to general anesthesia for abdominal surgery in patients with severe pulmonary impairment.
abstract: BACKGROUND
  It is known that smokers and patients with chronic obstructive pulmonary disease (COPD) experience a higher rate of pulmonary-related complications following abdominal surgery. The impact of anesthetic technique (regional [RA] versus general [GA] versus combination of both) on the complication rate has not been established. This study examined the outcomes of abdominal surgery performed using RA (epidural or continuous spinal) as the sole anesthetic technique in patients with severe pulmonary impairment (SPI).
  
  
  METHODS
  We reviewed a series of 8 general surgery cases performed using RA alone (T4-T6 sensory level) in patients with SPI, as evidenced by an forced expiratory volume in 1 second (FEV(1)) less than 50% predicted and/or home oxygen requirement. One patient also received postoperative epidural analgesia. FEV(1) ranged from 0.3 to 1.84 L; 3 patients required home oxygen therapy, and 5 of the 8 were American Society of Anesthesiology (ASA) class 4. Operations included segmental colectomy (n = 2), open cholecystectomy (n = 1), incisional herniorrhaphy (n = 1), and laparoscopic herniorrhaphy (n = 4).
  
  
  RESULTS
  Intraoperative conditions were adequate with RA alone for successful completion of the procedure in all cases. All patients recovered uneventfully except for 1 who developed postoperative pneumonia that resolved with standard therapy. Length of stay was less than 24 hours for 5 of 8 patients. Mortality was 0%.
  
  
  CONCLUSIONS
  Abdominal surgery can be safely performed using RA alone in selected high-risk patients, making this option an attractive alternative to GA for those with severe pulmonary impairment.
authors.affiliation: Department of Surgery and Anesthesia, Hunter Holmes McGuire Veterans Affairs Medical Center, Virginia Commonwealth University Medical Center, 1201 Broad Rock Blvd., Richmond, VA 23249, USA. jeannie.savas@med.va.gov
authors.forename: Jeannie F
authors.initials: JF
authors.lastname: Savas
authors.forename: Robert
authors.initials: R
authors.lastname: Litwack
authors.forename: Kevin
authors.initials: K
authors.lastname: Davis
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Miller
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000762:Anesthesia Recovery Period; D000765:Anesthesia, Conduction / Q000379:methods*; D015331:Cohort Studies; D004066:Digestive System Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome