Successful Thoracic Segmental Spinal Epidural Anesthesia in a High-Risk Septic Laparoscopic Cholecystectomy Patient with Parkinson's Disease – Case Report.

Abstract

Patients with Parkinson's disease present unique challenges in the perioperative setting due to their neurodegenerative condition, which can affect motor function and autonomic control. This case report describes the management of a 75-year-old hypertensive male with Parkinson's disease who was admitted with altered consciousness, suspected sepsis, and a ruptured septic gallbladder requiring urgent laparoscopic cholecystectomy and umbilical hernia repair. The patient was treated with combined segmental spinal epidural anesthesia, allowing for anaesthesia and effective pain control while minimizing hemodynamic and airway risks associated with general anesthesia. Initial resuscitation included non-invasive ventilation and low-dose noradrenaline support to stabilize blood pressure and oxygen saturation. The anesthesia plan prioritized regional techniques, which facilitated a smooth intraoperative course and maintained the patient’s hemodynamic stability. Postoperatively, the patient required intravenous fluids and antibiotics, and by day two, noradrenaline support was discontinued. The epidural catheter was removed on day three, with the patient showing steady recovery progress. The continued use of  antiparkinsonian medications throughout the perioperative period further contributed to favorable outcomes. After eight days in the hospital, the patient was discharged in stable condition. This case underscores the potential benefits of using segmental spinal anesthesia in high-risk surgical scenarios, particularly for elderly patients with complex medical histories. It supports existing literature that advocates for regional anesthesia as a viable alternative to general anesthesia in similar cases, warranting further studies to validate these findings in diverse patient populations.