Segmental thoracic spinal anesthesia- an alternative anesthesia technique for cholecystectomy in a pre-diagnosed case of congenital adrenal hyperplasia: a case report

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder of defective steroidogenesis. Perioperative care of the patient with CAH should be focused on concerns related to deficiency and excessive production of specific hormones secreted by the adrenal cortex as well as on chronic steroid therapy. Cholecystectomy can be done under various anesthetic techniques; however, the administration of general anesthesia (GA) is the most common of them. Open cholecystectomy has been successfully managed under regional anesthesia. Surgery and anesthesia-related stress response could be responsible for the unsatisfactory outcome in patients with CAH in which cortisol secretion is already hampered. Thus, modulation and reduction of this stress response during the perioperative period can significantly alter postoperative outcomes in such patients. The choice of anesthetic technique with minimal provocation of the stress response is the mainstay of using thoracic segmental spinal anesthesia for cholecystectomy in this patient. This case report describes the successful anesthetic management of an adult patient with CAH under thoracic segmental spinal anesthesia posted for open cholecystectomy.