P003 Thoracic segmental spinal anesthesia for laparoscopic cholecystectomy

<h3>Background and Aims</h3> The advent of laparoscopic procedures has revolutionized the medical field by offering several benefits, including smaller incisions, reduced bleeding, minimal surgical surgical and pulmonary complications during and after surgery, and shorter hospital stays which overall results to a reduction of medical cost. GA is the technique usually performed due to the various effects of insufflation on the respiratory and cardiovascular system of the body. This case report aims to discuss the application of the segmental thoracic spinal anesthesia as an alternative. <h3>Methods</h3> A 33-year old ASA II was scheduled for laparoscopic cholecystectomy for cholelithiasis. Appropriate landmarks were palpated and confirmed using ultrasound. TSA was done using a quincke G23 spinal needle was inserted via a paramedian approach at the level of T-8–9 with a mixture of Bupivacaine Isobaric 5 mg and bupivacaine heavy 2.5 mg with the following adjuvants - Fentanyl 12.5 mcg, ketamine 20 mg and Dexmedetomidine 10 mcg. The patient was slowly placed in a supine position and sensation was assessed using a pinprick test. <h3>Results</h3> A sensory block between the T2-T10 levels was confirmed. Surgery started, Vital signs monitoring showed blood pressure ranges 79–120/48–80 mmHg, with one hypotensive episode during insufflation, managed with Ephedrine 10 mg intravenously; heart rate range of 39 to 90 bpm with 1 episode of bradycardia managed with atropin 0.71 mg intravenously. Patient‘s vitals were kept within acceptable limits throughout the procedure. Procedure lasted 2 hours and 6 minutes. There is adequate relaxation and exposure, and the surgeon is satisfied with the technique. No adverse effects were recorded preoperatively. <h3>Conclusions</h3> Evidence suggests that spinal anesthesia can be safely used in laparoscopic surgeries with minimal side effects that can be effectively managed using available pharmacological interventions. The success of this procedure using TSA as our technique is indeed a safe and, in some ways has advantages of GA.