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To the Editor: Open cholecystectomy (OC) usually necessitates general anesthesia and endotracheal intubation. General anesthesia + epidural anesthesia (EA), thoracic EA, EA + intrapleural anesthesia, EA + iv anesthesia, and EA + local anesthesia have been used for upper abdominal surgery (UAS) in patients with pulmonary disease previously. 1–3 Although celiac plexus blockade (CPB) can be recommended as an adjunct to EA for UAS, it is not common because of technical difficulties and risks. We report the effects of combined CPB and EA on metabolic and endocrine responses to surgery, respiratory function and pain intensity in two patients with chronic obstructive pulmonary disease (COPD) for OC. Case 1: A woman (44 yr old) with chronic cholelithiasis had bronchiectasis (wheezing, sibilant rhonchi and clubbing) for ten years. (FEV 1 / FVC: 60% and pH: 7.43, PaCO 2 : 29 mmHg, PaO 2 : 85 mmHg, BE: -3 mmol·L –1 , SaO 2 : 96%.) Case 2: A woman (65 yr old) had COPD (expiratory wheezing and rhonchi) and hypertension. (FEV 1 / FVC: 58%, pH: 7.46, PaCO 2 : 44 mmHg, PaO 2 : 70 mmHg, BE: 6.9 mmol·L –1 , SaO 2 : 95%). Both patients were admitted for OC. Other laboratory tests were

Lumbar epidural anesthesia and celiac plexus blockade for cholecystectomy in two patients with severe chronic obstructive pulmonary disease