Laparoscopic cholecystectomy under continuous epidural anesthesia in patients with cystic fibrosis.

Sir. —Patients with cystic fibrosis often develop cholelithiasis. Subsequently, many will suffer from symptoms of their gallstones and develop cholecystitis. Because of the high risks associated with induction of anesthesia in patients whose pulmonary status is compromised, surgery is sometimes delayed or avoided. With the advent of laparoscopic cholecystectomy and anesthetic techniques such as epidural blockade, another option is available that may be safe for many of these patients. I describe a patient whose surgical and anesthetic care was unique. Patient Report. —An 18-year-old man with cystic fibrosis, severe recurrent pneumonia caused by Pseudomonas aeruginosa , and bronchiectasis was admitted to the Baptist Hospital of Miami (Fla) with worsening midepigastric pain, bilious vomiting, belching, and inability to eat. He had a 2- to 3-year history of biliary colic after eating certain foods. An ultrasound examination revealed multiple small gallstones in a contracted gallbladder; the gallbladder was not visualized after 4