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首页> 外文期刊>Local and Regional Anesthesia >Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency
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Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

机译：胸腔联合硬膜外麻醉用于老年缺血性心脏病和肾功能不全患者的腹腔镜胆囊切除术

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Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency.
机译：进行任何手术的老年人由于生理储备，相关合并症，多药，认知功能障碍和虚弱而下降，因此发病率和死亡率较高。大多数比较老年人局部麻醉与全身麻醉的临床试验未能证明任何单一技术的优越性。但是，老年人的理想方法是微创，从而最大程度地减少体内平衡的改变。腹腔镜手术中麻醉管理的目标包括气腹的管理，在没有任何呼吸损害的情况下达到足够的感觉阻滞水平，管理肩尖疼痛，提供适当的术后疼痛缓解以及早期活动。区域麻醉符合所有上述标准并有助于快速恢复，因此建议将其用作腹腔镜手术的全身麻醉的合适替代方法，特别是在全身麻醉时处于高风险的患者或不愿进行全身麻醉的患者。总之，我们报告了老年合并缺血性心脏病，慢性阻塞性肺疾病和肾功能不全的老年患者的胸腔镜联合硬膜外胸腔镜成功治疗的结果。

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