Spinal Anesthesia in Laparoscopic Cholecystectomy in a 75 Years Old Patient with Congestive Heart Failure NYHA III

Laparoscopic cholecystectomy (LC) is a relatively common surgical procedure which is generally performed under general anesthesia. We report a case of a 75-year old female patient presented to our emergency with cholecystitis acute symptoms. She had been diagnosed formerly with pneummonia and pleuritis and she was a heavy smoker. Other risk factors included diabetes mellitus type II, left nephrectomy and age. Two months before presenting to our hospital she had a coronary angiography and had a revascularization of LAD artery with PCI and a DES implanted. Echocardiography show ed an EF of 15-20%, apical aneusysm and an adhered septal thrombus. After the surgery consult the patient was recommended for a surgical removal of the gallbladder under laparoscopic approach. Upon arrival at the operating room routine monitoring was established. The patient liedon theright lateral side so that spinal anesthesia could be performed. A 24G spinal needle was used to enter the subarachnoid space at the T6-T7 intervertebral space under complete aseptic technique. Bupivacaine 0.25% 3.5ml was injected so that a sensory loss up to T4 dermatome was achieved. The procedure lasted for about 60 minutes without any complications.