Anesthetic management of endovascular repair for aortic abdominal aneurysm in a patient with severe chronic obstructive pulmonary disease

A 66-year-old man with severe chronic obstructive pulmonary disease (COPD) was scheduled for elective endovascular repair of an aortic abdominal aneurysm and femoral-femoral artery bypass. Because spirometry revealed marked reduction of percent forced expiratory volume in 1 second (% FEV_1.0), postoperative respiratory failure was anticipated. Spinal anesthesia and no use of tracheal intubation were planned. When the patient entered the operating room, his oxygen saturation (SpO₂) was 92%. Four ml of isobaric 0.5% bupivacaine was injected intrathecally at the L3-4 inter-space using a 25-gauge spinal needle. After the final analgesic level of the spinal anesthesia had been ensured at T6, 1.0% lidocaine 5 ml was injected intradermally in the right elbow for insertion of a catheter sheath. Additional analgesia was acquired with a total of 0.1 mg of fentanyl IV. The endovascular repair was completed uneventfully. In conclusion, spinal anesthesia combined with local anesthesia in the elbow is useful for management of endovascular repair of an aortic abdominal aneurysm in patients with severe COPD for whom postoperative respiratory failure is anticipated.