Open Cholecystectomy in Respiratory and Cardiovascular disease patients under Lumbar combined Spinal-Epidural Anesthesia
Background and Aims: Regional anesthesia gained popularity over the last three decades due to the technical advances across subdisciplines, better understanding of the physiology, the advances in the field of anesthetic drugs, and the better approach in training for such techniques. The technique is currently used in many anatomical levels and most surgical procedures can be performed using the combined spinal epidural type.
The aim of this study is to evaluate the feasibility of the combined spinal-epidural anesthesia in patients with respiratory and cardiovascular diseases who underwent open cholecystectomy.
Patients and methods: This prospective cross sectional study which was done on patients undergoing elective open cholecystectomy (n=119) for whom the general anesthesia was contraindicated due to major cardiovascular and pulmonary diseases, under lumber combined spinal-epidural anesthesia.
Results: The mean age of our patients was 64.33(SD: 12.085) years; females constituted 73 of them (61.3%) and males 46 (38.7%). Most patients (73) were complaining from the cardiovascular diseases (61.34%). In most patients the onset of the action of the anesthesia was between 10-12 minutes. In 55 patients (46.2%) no extra-drugs were required, and in the rest of patients intravenous mediations were given to relieve anxiety, pain, or both. In 81 patients (68.1%) no intraoperative complications were reported, the most common intraoperative complication was hypotension in 31 patients (26.1%), post-operatively no complications were reported in 86 patients (72%), and hypotension was reported in 12 patients (10.1%), nausea & vomiting in 11 patients (9.2%). The surgeon’s satisfaction was excellent in 73.11% of the surgeries, as was good in 23.53%. Most patients gained the lower limb movement within 2 hours. There was a significant correlation between the need for extra drugs and both comorbid diseases and the development of intraoperative complications (P values 0.022 & 0.000) respectively and no significant correlations with other parameters such as the gender, postoperative complications and the surgeon’s satisfaction (P values 0.707, 0.522, and 0.056) respectively.
The technique of the combined spinal epidural anesthesia is safe and very effective when used for American Society of Anesthesiologist (ASA) patient classification class III and IV patients who need open cholecystectomy. This technique should be used by expert anesthetists who are well trained and gained skill in this technique, and it may be used in fields other than surgery such as trauma victims and for cancer patients.
Clemente, A., & Carli, F. (2008). The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems. Minerva Anestesiol, 74(10), 549-563.
Das, W., Bhattacharya, S., Ghosh, S., Saha, S., Mallik, S., & Pal, S. (2015). Comparison between general anesthesia and spinal anesthesia in attenuation of stress response in laparoscopic cholecystectomy: A randomized prospective trial. Saudi journal of anaesthesia, 9(2), 184.
Donmez, T., Erdem, V. M., Uzman, S., Yildirim, D., Avaroglu, H., Ferahman, S., & Sunamak, O. (2017). Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study. Annals of surgical treatment and research, 92(3), 136-142.
Ellakany, M. (2013). Comparative study between general and thoracic spinal anesthesia for laparoscopic cholecystectomy. Egyptian Journal of Anaesthesia, 29(4), 375-381.
Ellakany, M. H. (2014). Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery. Anesthesia, essays and researches, 8(2), 223.
Gramatica, L., Brasesco, O., Luna, A. M., Martinessi, V., Panebianco, G., Labaque, F., . . . Rosenthal, R. (2002). Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surgical Endoscopy and Other Interventional Techniques, 16(3), 472-475.
Hamad, M., & El-Khattary, O. I. (2003). Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study. Surgical Endoscopy and Other Interventional Techniques, 17(9), 1426-1428.
Khan, M. N., Ashraf, M. N., & Khan, H. D. (2013). Spinal anesthesia versus general anesthesia for open cholecystectomy: comparison of postoperative course. Ann Pak Inst. Med Sci, 9, 95-98.
Kumar Ashish, M., Koshire Alka, M., & Bharadwaj Deepti, D. (2016). A case series of use of combined spinal epidural anesthesia for laparoscopic appendectomy in adults. Age (in years), 33, 22-45.
Lee, J. H., Huh, J., Kim, D. K., Gil, J. R., Min, S. W., & Han, S. S. (2010). Laparoscopic cholecystectomy under epidural anesthesia: a clinical feasibility study. Korean Journal of Anesthesiology, 59(6), 383.
Lee, R., Van Zundert, A., Visser, W. A., Lataster, L. A., & Wieringa, P. A. (2008). Thoracic combined spinal-epidural (CSE) anaesthesia. Southern African Journal of Anaesthesia and Analgesia, 14(1), 63-69.
Mehta, P. J., Chavda, H. R., Wadhwana, A. P., & Porecha, M. M. (2010). Comparative analysis of spinal versus general anesthesia for laparoscopic cholecystectomy: A controlled, prospective, randomized trial. Anesthesia, essays and researches, 4(2), 91.
Mohammed, A. A., & Arif, S. H. (2019). Midline gallbladder makes a challenge for surgeons during laparoscopic cholecystectomy; case series of 6 patients. Annals of Medicine and Surgery, 40, 14-17.
Naja, Z., & Lönnqvist, P. A. (2001). Somatic paravertebral nerve blockade incidence of failed block and complications. Anaesthesia, 56(12), 1181-1201.
Ortiz, J., Suliburk, J. W., Wu, K., Bailard, N. S., Mason, C., Minard, C. G., & Palvadi, R. R. (2012). Bilateral transversus abdominis plane block does not decrease postoperative pain after laparoscopic cholecystectomy when compared with local anesthetic infiltration of trocar insertion sites. Regional Anesthesia and Pain Medicine, 37(2), 188-192.
Tulgar, S., Kapakli, M. S., Senturk, O., Selvi, O., Serifsoy, T. E., & Ozer, Z. (2018). Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial. Journal of Clinical Anesthesia, 49, 101-106.
Van Zundert, A., Stultiens, G., Jakimowicz, J., Peek, D., Van der Ham, W., Korsten, H., & Wildsmith, J. (2007). Laparoscopic cholecystectomy under segmental thoracic spinal anaesthesia: a feasibility study. British journal of anaesthesia, 98(5), 682-686.
Van Zundert, A., Stultiens, G., Jakimowicz, J., Van den Borne, B., Van der Ham, W., & Wildsmith, J. (2006). Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease. BJA: British Journal of Anaesthesia, 96(4), 464-466.
Copyright (c) 2021 Haidar Nasser Mohammed
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
At Zanco Journal, we're dedicated to protecting your rights as an author, and ensuring that any and all legal information and copyright regulations are addressed. Whether an author is published with Zanco Journal or any other publisher, we hold ourselves and our colleagues to the highest standards of ethics, responsibility and legal obligation