Laparoscopic cholecystectomy under spinal anesthesia in high risk patients: A single center experience

Aim: Laparoscopic cholecystectomy is routinely done with general anesthesia except for patients that are considered too sick for general anesthesia. The goal of this study was to investigate the availability, safety, and side effects of spinal anesthesia in laparoscopic cholecystectomy.Material and Methods: Patients with high risk for general anesthesia who admitted for laparoscopic cholecystectomy were given the choice of spinal anesthesia instead of general anesthesia. In Ortadogu Private Hospital, Adana, Turkey; 371 subjects were prospectively admitted for laparoscopic cholecystectomy under spinal anesthesia between January 2015 and January 2018. All volunteers provided informed consent. The spinal anesthesia procedure was done similar to the general anesthesia protocol with no modifications. Intra-abdominal pressure was sustained within the 8-10 mmHg range. A 3.5mL bupivacaine (0.5%)/fentanyl (20 μg) mixture was used for spinal anesthesia. Data collected for demographics, ASA scores, surgery duration, comorbidities, and sedation medication/dosage were reviewed.Results: A total of 232 women (62.6%) and 139 men (37.4%) comprised the study. The subjects averaged 51 years of age (range: 37-89). Patients were classified into the following ASA categories: ASA II: 48 subjects (12.9%), ASA III: 197 subjects (53.1%), ASA IV: 126 subjects (34.0%). Surgery was performed successfully in 371 patients. Spinal anesthesia was adapted to general anesthesia for 2 (0.5%) subjects. The average operation time was 38.1 minutes (range: 16-74 minutes). O2 saturation was 97.8% on average for all patients. Right shoulder pain was documented in 14.5% of the patients, and a shoulder massage alleviated the discomfort in most subjects.Conclusions: Spinal anesthesia should be the anesthesia of choice dues to its numerous advantages in high-risk patients related to general anesthesia.

PDF

___

1. Soper NJ, Stockmann PT, Dunnegan DL, et al. Laparoscopic cholecystectomy. The new ‘gold standard’? Arch Surg 1992;127:917-21.
2. Kar M, Kar JK, Debnath B. Experience of laparoscopic cholecystectomy under spinal anesthesia with low-pressure pneumoperitoneum--prospective study of 300 cases. Saudi J Gastroenterol 2011;17:203-7.
3. Mehta PJ, Chavda HR, Wadhwana AP, et al. Comparative analysis of spinal versus general anesthesia for laparoscopic cholecystectomy: A controlled, prospective, randomized trial. Anesth Essays Res 2010;4:91-5.
4. Sinha R, Gurwara AK, Gupta SC. Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A 2009;19:323-7.
5. Tzovaras G, Fafoulakis F, Pratsas K, et al. Laparoscopic cholecystectomy under spinal anesthesia: a pilot study. Surg Endosc 2006;20:580-2.
6. Gramatica L Jr, Brasesco OE, Mercado Luna A, et al. Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surg Endosc 2002;16:472-5.
7. Pursnani KG, Bazza Y, Calleja M, et al. Laparoscopic cholecystectomy under epidural anesthesia in patients with chronic respiratory disease. Surg Endosc 1998;12:1082-4.
8. Savas JF, Litwack R, Davis K, et al. Regional anesthesia as an alternative to general anesthesia for abdominal surgery in patients with severe pulmonary impairment. Am J Surg 2004;188:603-5.
9. De Jonghe B, Cook D, Appere-De-Vecchi C, et al. Using and understanding sedation scoring systems: a systematic review. Intensive Care Med 2000;26:275-85.
10. Yuksek YN, Akat AZ, Gozalan U, et al. Laparoscopic cholecystectomy under spinal anesthesia. Am J Surg 2008;195:533-6.
11. Imbelloni LE, Sant’anna R, Fornasari M, et al. Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose hyperbaric bupivacaine. Local Reg Anesth 2011;4:41-6.
12. Kumar A. Laparoscopic cholecystectomy under spinal anesthesia: a prospective study. Nepal Med Coll J 2014;16:139-43.
13. Tiwari S, Chauhan A, Chaterjee P, et al. Laparoscopic cholecystectomy under spinal anesthesia: A prospective, randomized study. J Minim Access Surg 2013;9:65-71.
14. Kim BS, Joo SH, Joh JH, et al. Laparoscopic cholecystectomy in patients with anesthetic problems. World J Gastroenterol 2013;19:4832-5.
15. Tekelioglu UY, Erdem A, Demirhan A, et al. The prolonged effect of pneumoperitoneum on cardiac autonomic functions during laparoscopic surgery; are we aware? Eur Rev Med Pharmacol Sci 2013;17:895-902.
16. Ishizaki Y, Bandai Y, Shimomura K, et al. Safe intraabdominal pressure of carbon dioxide pneumoperitoneum during laparoscopic surgery. Surgery 1993;114:549-54.
17. V K, Pujari VS, R SM, et al. Laparoscopic Cholecystectomy Under Spinal Anaesthesia vs. General Anaesthesia: A Prospective Randomised Study. J Clin Diagn Res 2014;8:NC01-04.
18. Liu X, Wei C, Wang Z, et al. Different anesthesia methods for laparoscopic cholecystectomy. Anaesthesist 2011;60:723-8.
19. Taşpinar V, Saçan Ö, Başkan S, et al. Spinal anesthesia for a patient with obstructive jaundice and acute bronchitis J Anesthesia 2009;17:94-7.
20. Bayrak M, Altıntas Y. Comparing laparoscopic cholecystectomy in patients with chronic obstructive pulmonary disease under spinal anesthesia and general anesthesia. BMC Surg 2018;18:65.