Thoracic Segmental Spinal Anesthesia for Bullectomy in a Patient With Severe Pulmonary Compromise: A Case Report
Abstract
Background Thoracic surgery is conventionally performed under general anesthesia with one‐lung ventilation. However, this approach may pose considerable perioperative risks in selected patients with advanced pulmonary disease and significant medical comorbidities. Thoracic segmental spinal anesthesia (TSSA), combined with adjunctive regional techniques, has emerged as a potential alternative in carefully selected high‐risk patients undergoing nonintubated thoracic surgery [1–3]. Presentation A 76‐year‐old man with spontaneous left‐sided pneumothorax, persistent air leak despite chest tube drainage and two autologous blood patch pleurodesis attempts, resolving pneumonia, cerebellar atrophy, parkinsonian tremor, and anterior fascicular block was referred for surgical management. His respiratory reserve was severely compromised, with oxygen saturation decreasing to 72% before admission and persistent oxygen dependence despite chest drainage [1,2]. Pulmonary function testing could not be performed because of his clinical condition. Following multidisciplinary discussion, conventional general anesthesia with one‐lung ventilation was considered to carry a substantial perioperative respiratory risk. The patient subsequently underwent awake video‐assisted thoracoscopic surgery (VATS) under low‐dose TSSA at the T5–T6 interspace using 6 mg isobaric bupivacaine, combined with an ultrasound‐guided cervical vagus nerve block using 4 mL of 1% lidocaine to suppress the intraoperative cough…
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