Laparoscopic cholecystectomy, using subarachnoidal anesthesia in spontaneous respiration
Objective. To analyze the results of application of subarachnoidal anesthesia while spontaneous respiration during performance of laparoscopic cholecystectomy (LCHE) for improvement of the regional anesthesia, while doing operations on abdominal organs.
Маterials and methods. In 549 patients, put to Class I-III in accordance to classification of American Society of Anesthesiology (ASA), ageing from 25 tо 82 yrs and at average (48.9 ± 13.1) yrs old, LCHE was performed with pneumoperitoneum, which was established, using intraabdominal blowing with CO2 and subarachnoidal anesthesia on spontaneous respiration. For an acute cholecystitis 319 (58.1%) patients were operated and for chronic calculous cholecystitis - 230 (41.9%). Of 319 patients, suffering an acute cholecystitis, 278 (87.4%) have had destructive forms. Іntraoperative parameters, іntensity of postoperative pain and the restoration measure in total, аs well as the patients’ satisfaction measuring, were registered while prospective observation performance with objective to investigate the procedure’s safety and possibilities.
Results. All the operations were finished laparoscopically, in no one observation conversion to subarachnoid anesthesia into general one was needed. The pain intensity during 4 h after the operation have constituted 1.6 ± 1.1 (diapason 0 - 5), in 8 h – 1.2 ± 0.9 (diapason 0 - 6), in 24 h – 1.02 ± 0.7 (diapason 0-5). All the patients were discharged in 1 - 7 days.
Conclusion. LCHE with CO2 pneumoperitoneum may be performed successfully and securely, using subarachnoidal anesthesia on spontaneous respiration. Besides this, spinal anesthesia is connected with minimal postoperative pain and, at least with similar measure of restoration, as it occurs while application of general anesthesia.
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