Elderly patient receiving gentle anesthesia in a futuristic operating room

Gentle Anesthesia: Laparoscopic Surgery's Unsung Hero for Seniors

Avery Sinclair in Health & Wellness November 2025 • 4 min read.

"Explore how thoracic combined spinal epidural anesthesia revolutionizes surgical safety for older adults with heart and kidney concerns."

As we age, undergoing surgery can become a higher-stakes gamble. Older adults often face a greater risk of complications and mortality due to the natural decline in physiological functions, existing health conditions, and the multitude of medications they may be taking. This complex interplay of factors requires a delicate balance in medical care, particularly when it comes to anesthesia.

While numerous clinical trials have attempted to determine whether regional or general anesthesia is superior for elderly patients, a definitive answer remains elusive. However, the guiding principle in geriatric anesthesia is clear: the least invasive approach is often the best. By minimizing disruptions to the body's delicate equilibrium, medical professionals can enhance patient safety and promote better outcomes.

Laparoscopic procedures present unique challenges in anesthesia, including managing the effects of pneumoperitoneum (the introduction of gas into the abdominal cavity), achieving adequate pain relief, and ensuring early mobilization. Regional anesthesia, with its ability to meet these criteria while minimizing respiratory compromise and providing effective postoperative pain management, has emerged as a promising alternative to general anesthesia.

A Case of Successful Thoracic Combined Spinal Epidural Anesthesia

Elderly patient receiving gentle anesthesia in a futuristic operating room

In a compelling case, doctors report the successful use of thoracic combined spinal epidural anesthesia for a geriatric patient undergoing laparoscopic cholecystectomy. The patient, an 88-year-old male with a history of ischemic heart disease, chronic obstructive pulmonary disease (COPD), and renal insufficiency, presented a complex set of challenges. His medical history included frequent episodes of right hypochondrial pain due to multiple small gallstones, along with dyspnea on minimal exertion.

After careful consideration and extensive discussions with specialists, the medical team opted for thoracic combined spinal epidural (CSE) anesthesia. This technique involves a combination of spinal and epidural anesthesia, allowing for precise control over pain and minimizing the potential for respiratory complications. The CSE procedure was performed meticulously, with continuous monitoring of the patient's vital signs.

The benefits of this approach were clear:

Effective Pain Management: The patient experienced minimal discomfort during and after the procedure.
Hemodynamic Stability: The anesthesia maintained stable blood pressure and heart rate.
Respiratory Support: The patient was able to breathe comfortably without the need for mechanical ventilation.
Early Mobilization: The patient was able to get out of bed and start moving around soon after the surgery.

The laparoscopic cholecystectomy was performed without complications, and the patient remained hemodynamically stable throughout the procedure. Postoperatively, he received epidural analgesia to manage any discomfort and was closely monitored in the surgical intensive care unit. He was soon discharged, demonstrating the effectiveness and safety of this approach.

The Future of Anesthesia in Geriatric Care

The successful management of this case underscores the potential of thoracic combined spinal epidural anesthesia as a valuable tool for geriatric patients undergoing laparoscopic surgery. By carefully assessing patients preoperatively and tailoring the anesthetic approach to their individual needs, medical professionals can minimize risks and optimize outcomes. This technique offers a promising avenue for improving the safety and comfort of older adults facing surgical interventions.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2147/lra.s86390, Alternate LINK

Title: Thoracic Combined Spinal Epidural Anesthesia For Laparoscopic Cholecystectomy In A Geriatric Patient With Ischemic Heart Disease And Renal Insufficiency

Subject: Anesthesiology and Pain Medicine

Journal: Local and Regional Anesthesia

Publisher: Informa UK Limited

Authors: Mohd Reidwan Dar, Nandita Mehta, Sunana Gupta, Atul Sharma

Published: 2015-12-01

Everything You Need To Know

What is thoracic combined spinal epidural anesthesia, and why is it particularly useful for older adults?

Thoracic combined spinal epidural anesthesia is a specialized technique combining spinal and epidural anesthesia. This allows doctors to precisely control pain while minimizing the risk of respiratory complications in elderly patients during laparoscopic procedures. It's particularly useful for those with pre-existing heart or lung conditions.

What are the main benefits of using thoracic combined spinal epidural anesthesia in elderly patients undergoing laparoscopic surgery?

The primary advantage of using thoracic combined spinal epidural anesthesia in elderly patients is that it minimizes disruption to the body's equilibrium. Specifically, the case described highlights effective pain management, hemodynamic stability (stable blood pressure and heart rate), respiratory support without mechanical ventilation, and early mobilization. These benefits reduce post-operative complications and promote faster recovery.

How does thoracic combined spinal epidural anesthesia address the challenges posed by pneumoperitoneum in laparoscopic procedures?

Pneumoperitoneum, the introduction of gas into the abdominal cavity during laparoscopic surgery, can cause discomfort and physiological changes. Thoracic combined spinal epidural anesthesia helps manage the pain associated with pneumoperitoneum, ensuring the patient's comfort and stability. It also provides effective postoperative pain management, allowing for early mobilization, which is crucial for preventing complications like deep vein thrombosis in older adults.

What specific challenges did the 88-year-old patient in the case present, and why was thoracic combined spinal epidural anesthesia chosen for him?

In the reported case, the 88-year-old patient had ischemic heart disease, chronic obstructive pulmonary disease (COPD), and renal insufficiency, making him a high-risk candidate for surgery. Thoracic combined spinal epidural anesthesia was chosen because it allowed the medical team to manage his pain effectively while minimizing the strain on his respiratory and cardiovascular systems. This case illustrates how tailored anesthesia can benefit even the most complex geriatric patients.

What are the future implications and remaining challenges in using thoracic combined spinal epidural anesthesia for geriatric surgical patients?

While thoracic combined spinal epidural anesthesia shows promise, challenges remain in geriatric anesthesia. Clinical trials continue to explore the superiority of regional versus general anesthesia. The focus is always on the least invasive approach, minimizing physiological disruption. Future research will likely refine techniques and protocols to further enhance safety and outcomes for older adults undergoing surgical procedures, considering factors like frailty, cognitive function, and polypharmacy (the use of multiple medications).