ABSTRACT
BACKGROUND: Regional anesthesia has not been used as the sole anesthetic procedure other than in the scenario of a patient at high risk to undergo laparoscopic cholecystectomy with CO2 pneumoperitoneum under general anesthesia. METHODS: Fifteen ASA grade I or II patients underwent laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under spinal anesthesia. Intraoperative parameters, postoperative pain and recovery in general, as well as patient satisfaction at follow-up were prospectively recorded in a pilot study to assess the feasibility and safety of the procedure. RESULTS: All operations were completed laparoscopically and conversion from spinal to general anesthesia was not required in any of the cases. Median pain score 4 h postoperatively was 1.5 (range, 0-5), at 8 h it was 1 (range, 0-6), and at 24 h it was 1 (range, 0-4). All patients were discharged after 24 h. Follow-up 2 weeks postoperatively showed all but one patient to be satisfied and strongly recommending the anesthetic procedure. CONCLUSION: Laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum can be successfully and safely performed under spinal anesthesia. Furthermore, it seems that spinal anesthesia is associated with minimal postoperative pain and at least an equally good recovery as with general anesthesia.
Subject(s)
Anesthesia, Spinal , Carbon Dioxide , Cholecystectomy, Laparoscopic , Cholelithiasis/surgery , Pneumoperitoneum, Artificial , Adult , Cholecystectomy, Laparoscopic/adverse effects , Feasibility Studies , Female , Follow-Up Studies , Humans , Intraoperative Complications/physiopathology , Male , Middle Aged , Pain, Postoperative/physiopathology , Patient Satisfaction , Pilot Projects , Prospective Studies , Shoulder Pain/physiopathology , Treatment OutcomeABSTRACT
We have evaluated the use of a prototype lighted flexible catheter using the transillumination of the light through the soft tissues of the neck, as a detector of the accidental oesophageal intubation during the tracheal intubation through the intubating laryngeal mask. Two hundred patients undergoing general anaesthesia were studied. Accidental oesophageal intubation occurred in 12 patients (6%) during the first intubating attempt and was diagnosed by noting absence of glow on the neck during the tracheal tube advancement and was confirmed by capnography. However, 11/12 (92%) of the above patients were finally intubated successfully, using the lighted flexible catheter. In one patient persistent accidental oesophageal intubation occurred and was classified as failure.
