{
  "abstract": "Background and Aims General Anaesthesia provided for thoracic and upper abdominal surgeries poses high risk in patients with severe respiratory limitations. Thoracic segmental spinal anaesthesia provides an excellent alternative in these patients preserving lung function. This unorthodox technique has been of limited use in the past century with fear of injury to spinal cord and hemodynamic instability. Here, we represent 3 cases of breast excision and reconstruction surgeries successfully done with Thoracic segmental spinal anaesthesia, in patients with multiple comorbidities and severe lung disease, associated with higher risks from GA.Methods Pre-op assessment of these high risk patients, consent obtained after explaining risks and complications. Thoracic spinal done at T6-T7 interspace, with patient in sitting position. Done with 25-G pencil point needle i midline with necessary angulation. 1.5 ml of isobaric bupivacaine with 25 mcg of fentanyl was given. Patients were made to lie down supine after the spinal. Sensory loss to cold was present from T3 to T11. Surgery duration was 80–100 minutes. Patients were comfortable throughout the surgery.Results Minimal hemodynamic instability after the spinal managed with boluses of metarminol. No respiratory or breathing issues intra-op and post-op. Adequate surgical anaesthesia and pain relief provided by the spinal. No residual numbness or post-op complications. Patients were discharged the following day. A backup plan of GA was in place.Conclusions Thoracic segmental spinal anaesthesia has been associated with fewer hemodynamic alterations compared to traditional spinal and has multiple advantages over GA. It still requires a skillful and experienced anaesthesiologist to be performed appropriately. Use of ultrasound in identifying the space has resulted in higher success and is being increasingly used for thoracic, upper abdominal, breast and thoracscopic surgeries. Despite the absence of larger trials, multiple case reports and cohort studies have deemed it to be a safe and feasible alternative to general anaesthesia.",
  "authors": [
    {
      "affiliations": [
        "NHS, United Lincolnshire Hospitals NHS Trust, Lincoln, UK"
      ],
      "name": "Dinesh Suryanarayanarao"
    },
    {
      "affiliations": [
        "NHS, United Lincolnshire Hospitals NHS Trust, Lincoln, UK"
      ],
      "name": "Narendrasinh Padhiyar"
    },
    {
      "affiliations": [
        "NHS, United Lincolnshire Hospitals NHS Trust, Lincoln, UK"
      ],
      "name": "Vara Sagi"
    }
  ],
  "title": "P019 A case report of thoracic segmental spinal anaesthesia for 3 patients with severe lung disease for elective breast surgeries",
  "uid": "ec8397d8-bdc6-5974-8dd2-71fbc6bc36b7"
}