Laparoscopic cholecystectomy in patients with anesthetic problems.
Laparoscopic cholecystectomy is a standard operation for benign gallbladder disease. As experience with laparoscopic cholecystectomy has increased, the procedure has become possible in patients with anesthetic problems. Patients with ankylosing spondylitis or severe kyphosis represent a challenging group to anesthesiologists and laparoscopic surgeons since these diseases are associated with difficult intubation, restrictive ventilatory defects, and cardiac problems. The relatively new approach of awake fiberoptic intubation is considered to be the safest option for patients with anticipated airway difficulties. Laparoscopic cholecystectomy is usually performed under general anesthesia but considerable difficulties in anesthetic management are encountered during laparoscopic surgery; for example, hemodynamic instability may develop in patients with cardiopulmonary dysfunction due to pneumoperitoneum and position changes during the operation. Nonetheless, regional anesthesia can be considered as a valid option for patients with gallbladder disease who are poor candidates for general anesthesia due to cardiopulmonary problems. We report three cases of laparoscopic cholecystectomy successfully performed in patients with anesthetic problems that included cardiopulmonary disease, severe kyphosis, and ankylosing spondylitis.
Department of Surgery, School of Medicine, Kyung Hee University, Seoul 134-727, South Korea.
Bum-Soo
BS
Kim
Sun-Hyung
SH
Joo
Jin-Hyun
JH
Joh
Jae-Woo
JW
Yi
D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007738:Kyphosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D012140:Respiratory Tract Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016896:Treatment Outcome
Anesthetic problems; Ankylosing spondylitis; Kyphosis; Laparoscopic cholecystectomy