title: Effective awake thoracic epidural anesthetic for major abdominal surgery in two high-risk patients with severe pulmonary disease--a case report.
abstract: Awake thoracic epidural anaesthesia as the sole anaesthetic technique was successfully employed for two high risk surgical patients with chronic obstructive pulmonary disease undergoing abdominal surgery. The procedure was tolerated well and the anaesthetic technique which has been shown to reduce intra-operative and post-operative cardiac, respiratory and gastrointestinal complications, may have significantly contributed to the prompt, complication free recovery experienced by both patients. We report two cases of awake major abdominal surgery in two high-risk surgical patients with severe pulmonary disease, performed effectively under thoracic epidural anaesthesia as a sole technique. The first case was an elective open sigmoid colectomy in a sixty one year old cancerous patient with chronic obstructive pulmonary disease [COPD] and recent thoracotomy for a wedge resection of a bronchial adenocarcinoma [pT1NoMx]. The second case was an emergency open cholecystectomy in an adult patient with end-stage COPD. Reviewing the literature, no similar cases were reported recently.
authors.affiliation: Wishaw General Hospital, Wishaw, UK. prof.essamrazek@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Abd Elrazek
authors.forename: M
authors.initials: M
authors.lastname: Thornton
authors.forename: A
authors.initials: A
authors.lastname: Lannigan
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D002763:Cholecystectomy / Q000379:methods; D041881:Cholecystitis, Acute / Q000150:complications / Q000601:surgery; D003082:Colectomy / Q000379:methods; D016292:Procedural Sedation / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012307:Risk Factors; D012720:Severity of Illness Index; D012811:Sigmoid Neoplasms / Q000150:complications / Q000601:surgery*