Efficacy of thoracic epidural anesthesia for laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy is performed to minimize the postoperative morbidity and early return to work. This study was planned to evaluate the efficacy and feasibility of thoracic epidural anesthesia for laparoscopic cholecystectomy, so that it can be later used as anesthetic technique in patients when general anesthesia is not feasible. MATERIALS AND METHODS: Forty-eight adult consented patients of ASA grade I and II of either sex scheduled for elective laparoscopic cholecystectomy were enrolled for thoracic epidural anesthesia with 15 ml of 0.75% ropivacaine and 50 µg fentanyl. Intraoperative hemodynamic parameters and respiratory efficiency were recorded. Intra-operatively patient anxiety, pain, vomiting, hypotension or any other adverse event was managed with appropriate drug regime. Postoperative pain management with epidural analgesia, and bowel recovery were also recorded. RESULTS: The thoracic epidural anesthesia was effective for laparoscopic cholecystectomy in all except in two patients where conversion to general anesthesia was required. The hemodynamic parameters and respiratory efficiency were maintained within physiological limits. Only 4 patients required treatment for hypotension with vasopressor and 15 patients experienced shoulder pain, which was effectively managed with small doses of ketamine. The midazolam was required only in 11 patients for anxiety. The mean surgical time was 56.8±51.6 min. The 24-hour postoperative epidural infusion for analgesia was effective with limited effects on bowel and bladder function. Postoperatively only 3 patients had an episode of vomiting. There was good surgeon and patient's satisfaction. CONCLUSIONS: The thoracic epidural anesthesia with 0.75% ropivacaine and fentanyl for elective laparoscopic cholecystectomy is efficacious and has preserved ventilation and hemodynamic changes within physiological limits during pneumoperitoneum with minimal treatable side effects.

Deep vein thrombosis: review and update.

Deep vein thrombosis is a common and serious medical condition, which frequently complicates the postoperative recovery of surgical patients with recognised/unrecognised risk factors. The pathophysiology of formation of blood clots in veins of lower extremities has now come in light after development of newer investigations. Newer imaging techniques allow the evaluation of peripheral venous system, which was previously unavailable. Pulmonary embolism remains the major early complication of deep vein thrombosis, although postphlebitic syndrome and recurrent deep vein thrombosis are other major complications. The risk of both pulmonary embolism and postphlebitic syndrome escalates in patients with recurrent deep vein thrombosis. Thus a correct evaluation of patients at high risk and proper management is mandatory. With the development of low molecular weight heparin, the incidence of postheparin bleeding has been reduced.

Ileal obstruction: a rare complication due to appendicular band.

Acute intestinal obstruction as a result of inflammed appendix resulting in band formation in a 50-year-old male is being reported due to its rarity. The purpose of this paper is to draw attention to this rare complication of appendicitis as a cause for presenting as intestinal obstruction-delayed diagnosis of which results in intestinal strangulation and subsequent gangrene of the bowel loop. In this case, after diagnosis of intestinal obstruction, the patient was selected for exploratory laparotomy. The constricting band, incidentally the inflamed appendix along with the strangulated portion of the ileum was dissected out. The patient was discharged after 8 days without having any complications.