Spinal Anesthesia for Laparoscopic Cholecystectomy in Parkinson’s disease

Abstract

Parkinson’s disease, a neurodegenerative disorder, presents with resting tremor, muscle rigidity and bradykinesia. Affecting multiple organ-systems, it’s an important cause of peri-operative morbidity. General anaesthesia may deteriorate cardio-pulmonary and neuro-cognitive functions; moreover, medications used may interact with anti-parkinsonian agents. Spinal anaesthesia is usually avoided in Parkinson’s disease. However, it offers neurologic monitoring and less surgical stress response and avoids complications of general anaesthesia. This case report aims to demonstrate application of spinal anaesthesia for laparoscopic cholecystectomy in a Parkinson’s elderly with pulmonary dysfunction and anticipated difficult airway management. Sensory blockade of third thoracic dermatome was achieved. Bupivacaine was instilled intra-peritoneally. Surgery was smooth at low intra-abdominal pressure. Regular Paracetamol provided satisfactory post-operative analgesia. Single episode of post-operative vomiting was effectively managed. Without deterioration, patient was discharged from hospital on third day. Spinal anaesthesia is a valid technique for laparoscopic cholecystectomy in needy patients with multiple peri-operative risks.

<p>Spinal versus General Anesthesia for Patients with Parkinson’s Disease</p>

“…5 In addition, Gautam and Baral published a successful case of SA for laparoscopic cholecystectomy in an elderly patient with PD who had pulmonary dysfunction and was anticipated to have difficult airway management. 11 To the best of our knowledge, this is the first observational case series study that compares the effect of SA with GA on patients with PD who underwent hip fracture surgery. Our results revealed that SA poses less risk on such patients compared with GA.…”

Continuous erector spinae plane block for pain management in laparoscopic liver resection: case report

“…However, a sympathetic block in a patient with cardiovascular instability and autonomic dysfunction due to PD, can lead to sudden or exaggerated response to central neuraxial block as severe hypotension. 14 Benefits have been demonstrated in favor of abdominal wall blocks as part of an ERAS program for liver resection. 15 Frequently, oral and intravenous analgesic drugs are used for liver resection, but they may generate some undesiderable effects in multicomorbidities patients.…”