Emergency Awake Abdominal Surgery Under Thoracic Epidural Anaesthesia in a High-Risk Patient Within a Resource-Limited Setting

Roux, Johannes J. Le; Wakabayashi, Keiji; Jooma, Zainub

doi:10.7759/cureus.34856

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…A recent publication showed that thoracic epidural anaesthesia could be another feasible option for patients with severe pulmonary disease requiring an awake emergency laparotomy for bowel ischaemia in the absence of postoperative intensive care monitoring [39]. Though this is certainly an interesting alternative to general anaesthesia and NA, the article is only a single patient case study.…”

Section: Discussionmentioning

confidence: 99%

Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review

Leoni,

Rossi,

Mercieri

et al. 2024

Preprint

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Introduction Emergency laparotomy is a surgical procedure associated with significantly higher mortality rates compared to elective surgeries. Awake laparotomy under neuraxial anaesthesia has recently emerged as a promising approach in abdominal surgery to improve patient outcomes. This study aims to evaluate the feasibility and potential benefits of using lumbar spinal anaesthesia as the primary anaesthetic technique in emergency laparotomies. Methods We conducted a case series involving 16 patients who underwent emergency laparotomy for bowel ischemia, perforation, or occlusion. Lumbar spinal anaesthesia was employed as the main anaes-thetic technique. We analysed patient demographics, clinical characteristics, intraoperative details, and postoperative outcomes. The primary outcome measures included the adequacy of postoper-ative pain control, the incidence of postoperative complications, and mortality rates. Results Among the 16 patients, adequate postoperative pain control was achieved, with only 2 patients requiring additional analgesia. Postoperative complications, including sepsis, wound dehiscence, and pneumonia, were observed in 7 patients (44%). The observed mortality rate was relatively low at 6% (1 patient). Notably, conversion to general anaesthesia was not necessary in any of the cases, and no early readmissions were reported. Discussion Our findings highlight the feasibility and potential benefits of using neuraxial anaesthesia in emergency laparotomies. The observed low mortality rate and the avoidance of conversion to general anaesthesia suggest that lumbar spinal anaesthesia may be a useful alternative in emer-gency settings. However, the occurrence of postoperative complications in 44% of patients indi-cates the need for cautious patient selection and close monitoring. Further research with larger sample sizes is warranted to fully elucidate the efficacy, safety, and potential impact of this tech-nique on patient outcomes in emergency laparotomies.

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Section: Discussionmentioning

confidence: 99%

Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review

Leoni,

Rossi,

Mercieri

et al. 2024

Preprint

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Awake robotic liver surgery: A case report

Delvecchio,

Pavone,

Conticchio

et al. 2023

World J Gastrointest Surg

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BACKGROUND In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease. CASE SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal–epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful. CONCLUSION Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.

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Emergency Awake Abdominal Surgery Under Thoracic Epidural Anaesthesia in a High-Risk Patient Within a Resource-Limited Setting

Cited by 2 publications

References 12 publications

Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review

Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review

Awake robotic liver surgery: A case report

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