Case Report
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World J Gastroenterol. Aug 7, 2013; 19(29): 4832-4835
Published online Aug 7, 2013. doi: 10.3748/wjg.v19.i29.4832
Laparoscopic cholecystectomy in patients with anesthetic problems
Bum-Soo Kim, Sun-Hyung Joo, Jin-Hyun Joh, Jae-Woo Yi
Bum-Soo Kim, Sun-Hyung Joo, Jin-Hyun Joh, Jae-Woo Yi, Department of Surgery, School of Medicine, Kyung Hee University, Seoul 134-727, South Korea
Jae-Woo Yi, Departments of Surgery and Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul 134-727, South Korea
Author contributions: Yi JW performed the anesthesia; Kim BS and Joo SH performed the operations; Kim BS wrote the manuscript; Joh JH provided advice during manuscript preparation.
Supported by A grant from Kyung Hee University in 2010, KHU-20100653
Correspondence to: Sun-Hyung Joo, MD, PhD, Department of Surgery, School of Medicine, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, South Korea. sunhyung@chol.com
Telephone: +82-2-4406135 Fax: +82-2-4406295
Received: May 2, 2013
Revised: June 13, 2013
Accepted: June 19, 2013
Published online: August 7, 2013
Processing time: 95 Days and 18.4 Hours
Abstract

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.

Keywords: Laparoscopic cholecystectomy; Kyphosis; Ankylosing spondylitis; Anesthetic problems

Core tip: This paper reported three cases of laparoscopic cholecystectomy successfully performed in patients with anesthetic problems that included cardiopulmonary disease, severe kyphosis, and ankylosing spondylitis. This study demonstrates that 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.