Ventilatory Effects of Laparoscopy Under Epidural Anesthesia

Ciofolo, M. J.; Clergue, F.; Seebacher, J; Lefebvre, Guylaine; Viars, P.

doi:10.1097/00000542-198809010-00399

Cited by 19 publications

(24 citation statements)

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“…Under regional anesthesia the respiratory mechanism remains intact, and diaphragm the main respiratory muscle is unaffected allowing the patient to adjust minute ventilation without any significant changes in ventilatory parameters or CO 2 levels. 7 In a study conducted by Ciofolo et al, 13 the ventilatory measurements and arterial blood gases were maintained within normal limits at different stages during laparoscopy under epidural anesthesia. Data from healthier women undergoing laparoscopic surgery with CO 2 insufflation under RA suggest that PaCO 2 does not rise during surgery because awake women increase respiratory rate and minute ventilation.…”

Section: Discussionmentioning

confidence: 99%

Major laparoscopic surgery under regional anesthesia: A prospective feasibility study

Singh

Saini

Goel³

et al. 2015

Medical Journal Armed Forces India

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Background: Laparoscopic surgeries have attained the status of a gold standard for most of the abdominal pathology; we therefore performed this study to assess feasibility and safety of major laparoscopic surgeries like laparoscopic cholecystectomy (LC) and laparoscopic assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) under regional anesthesia that is combined spinal epidural anesthesia (CSE) with normal pressure pneumoperitoneum using intrathecal fentanyl with bupivacain.Methods: In a zonal government hospital, 50 patients were selected prospectively for LC and LAVH/TLH, under normal pressure (12 mmHg) pneumoperitoneum and under CSE over a span of fifteen months. Injection bupivacaine (0.5%) and 20 mg of fentanyl were used for spinal anesthesia. Plain bupivacaine (0.5%) was used for epidural anesthesia.Results: We successfully performed the operations in 48 patients without major complications. CSE was converted to general anesthesia in two patients due to distressing shoulder tip pain. Age varied between 25 and 70 years. Duration of operation time (skin to skin) was between 50 and 170 min. Five patients had urinary retention and one developed localized pruritis. There was no incidence of respiratory depression, aspiration or headache.Conclusion: Laparoscopic surgeries with normal pressure CO 2 pneumoperitoneum are feasible and safe under CSE. Incidence of postoperative shoulder pain was minimal due to use of intrathecal fentanyl and complications were less and easily manageable.

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Section: Discussionmentioning

confidence: 99%

Major laparoscopic surgery under regional anesthesia: A prospective feasibility study

Singh

Saini

Goel³

et al. 2015

Medical Journal Armed Forces India

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“…Genel anestezi altındaki hastalarda CO 2 'nin sistemik emilimi sonucu hiperkarbi meydana gelebilir. Ciofolo et al (17) laparoskopik kolesistektomi yapılacak olan hastalara epidural anestezi uygulamışlardır. Çalışmalarında girişim sonrası intraperitoneal alandan CO 2 uzaklaştırıldıktan 1 saat sonraki pCO 2 ile operasyondan önceki pCO 2 değerlerini karşılaştırmışlar ve anlamlı bir fark bulamamışlardır.…”

Section: Discussionunclassified

Experience of Laparoscopic Cholecystectomy Under Thoracic Epidural Anaesthesia: Retrospective Analysis of 96 Patients

Bilgi¹,

Alshair²,

Göksu³

et al. 2015

Turk J Anesth Reanim

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Objective: Although the traditional anaesthesia method for laparoscopic cholecystectomy has been general anaesthesia, regional anaesthesia techniques are also successfully used today. In this paper, we aimed to report our experiences with thoracic epidural anaesthesia, including complications, postoperative analgesia, technical difficulties and side effects. Methods:Between December 2009 and November 2012, 90 patients undergoing laparoscopic cholecystectomy were retrospectively analysed. Demographic data, American Society of Anesthesiologists (ASA) scores, comorbidities, duration of operations, medications and doses used for sedation were reviewed. Results:The gender distribution of patients were recorded as 15 males (15%) and 81 females (85%). The patients had an average age of 46.74±13.28, an average height of 162.50±5.57 cm and a mean weight of 73.57±12.48 kg. ASA classifications were distributed as follows: ASA I: 63 (65%) patients, ASA II 28 (29%) patients and ASA III: 5 patients. We recorded 3 patients with chronic obstructive pulmonary disease (COPD), 14 patients with diabetes mellitus (DM) and 22 patients with hypertension who got their diagnosis in the perioperative visit. During the operation, three patients had bradycardia (heart rate 50 min -1 ), and atropine was applied. Ephedrine and fluid resuscitation had been applied to 3 patients for the treatment of intraoperative hypotension. Midazolam, ketamine hydrochloride and propofol were administered to patients for sedation during the operations. Thoracic epidural anaesthesia was performed at the level of T7 -9 intervertebral space with the patients in the sitting position. Patients were given oxygen by a face mask at a rate of 3-4 L min -1 . The pneumoperitoneum was created by giving carbon dioxide at the standard pressure of 12 mmHg into the abdominal cavity in all patients. If needed, postoperative analgesia was provided by epidural local anaesthetic administration. Conclusion:Thoracic epidural anaesthesia can be applied as an alternative to general anaesthesia for laparoscopic cholecystectomy. Key Words: Laparoscopic cholecystectomy, thoracic epidural anaesthesia, pneumoperitoneumAmaç: Laparoskopik kolesistektomi ameliyatlarında geleneksel anestezi yaklaşımı genel anestezi uygulaması şeklindeyken günü-müzde rejyonal anestezi teknikleri de başarıyla kullanılmaktadır. Biz laparoskopik kolesistektomi girişimlerinde torakal epidural anestezi deneyimlerimizi, postoperatif analjezi uygulamalarımızı, saptadığımız teknik güçlükleri ve oluşan yan etki ve komplikasyonları sunmayı amaçladık.Yöntemler: Kasım 2009-Kasım 2012 tarihleri arasında laparoskopik kolesistektomi ameliyatı geçiren 90 hasta retrospektif olarak incelendi. Hastaların demografik verileri, American Society of Anesthesiologists (ASA) skorları, ek hastalıkları, sedasyon için kullanılan ilaçlar ve dozları, girişim süreleri, kayıtlardan tarandı. Bulgular:Hastaların cinsiyet dağılımı erkek 15 (%15), kadın 81 (%85) hasta, yaş ortalamaları 46,74±13,28, boy ortalamaları 162,50±5,57 cm, kilo ortalama...

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“…With general anesthesia, mechanical ventilation prevents acidosis by washing the excess CO 2 out of the lungs [6]. Because patients under epidural anesthesia do not normally receive mechanical ventilation, CO 2 partial pressure increases during surgery, which could potentially cause acidosis, which in turn could cause arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease

et al. 2001

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Ventilatory Effects of Laparoscopy Under Epidural Anesthesia

Cited by 19 publications

References 0 publications

Major laparoscopic surgery under regional anesthesia: A prospective feasibility study

Major laparoscopic surgery under regional anesthesia: A prospective feasibility study

Experience of Laparoscopic Cholecystectomy Under Thoracic Epidural Anaesthesia: Retrospective Analysis of 96 Patients

Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease

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