Laparoscopic cholecystectomy under spinal anesthesia in high risk patients: A single center experience
Mehmet Bayrak1, Yasemin Altintas2
1Middle East private Adana Hospital General Surgery, Adana, Turkey
2Middle East private Adana Hospital Radiologist, Adana, Turkey
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.