Laparoscopic cholecystectomy under segmental thoracic spinal anesthesia: A feasible economical alternative

Abstract

Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial. We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient. We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml−1 mixed with 0.5 ml of fentanyl 50 μg ml−1. Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension, or pruritus during or after surgery. The patient was reviewed 2 days postoperatively in ward. The thoracic spinal anesthetia was performed easily in the patient. Some discomfort which was readily treated with 1mg midazolam and 20 mg ketamine intravenously. There was no neurological deficit and hemodynamic parameters were in normal range intra and post-operatively and recovery was uneventful. We used a narrow gauze (26G) spinal needle which minimized the trauma to the patient and the chances of PDPH, which was more if 16 or 18G epidural needle had been used and could have increased further if there have been accidental dura puncture. Also using spinal anesthesia was economical although it should be done cautiously as we are giving spinal anesthesia above the level of termination of spinal cord.

Laparoscopic gynecological surgery under minimally invasive anesthesia: a prospective cohort study

“…Our data confirm the suitability of laparoscopy surgery under RA for gynecological surgery, a still debated subject in literature, in contrast to general surgery of which successful results are already reported in literature [14][15][16][17][18].…”

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia

“…This approach is also more cost effective for health providers. 2 In practice, laparoscopy is usually performed under general anesthesia, but regional anesthesia have proven useful. Spinal anesthesia is more effective than general anesthesia, especially in laparoscopic cholecystectomy.…”

Thoracic Segmental Spinal Anaesthesia/ General Anaesthesia for Laproscopy Surgery

“…However, considerable difficulties in anesthetic management could be encountered since wide hemodynamic fluctuation may develop due to pneumoperitoneum and position changes. [8] Pneumoperitoneum induces systemic effects due to the absorption of CO2, and in venous return due to the increase in intra-abdominal pressure [8]. Initially, absorption of CO2 increases its elimination in the expired air, in the arterial, and venous blood [8,9].…”

“…[8] Pneumoperitoneum induces systemic effects due to the absorption of CO2, and in venous return due to the increase in intra-abdominal pressure [8]. Initially, absorption of CO2 increases its elimination in the expired air, in the arterial, and venous blood [8,9]. This carboxemia induces metabolic and respiratory acidosis decreasing arterial and mixed venous pH and arterial PO2 [9].…”