Details
Category: Volume 06 Issue 07 July 2018
Hits: 1051

Title: Spinal Anesthesia versus General Anesthesia for open cholcystectomy: Comparison of PERI-operative and post-operative events

Authors: Charan Singh, Ashwini Nigam, Ram Bihari, Aziz Khan, Deepak Kumar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.180

Abstract

Objective: To study perioperative and postoperative events as well as feasibility, effectiveness, safety of patient and surgeons satisfaction for open cholecystectomy under spinal anesthesia (SA) compared to General Anesthesia (GA).

Material and Methods: All admitted and consented patients of grade ASA I and ASA II of either sex with diagnosed cholelethiasis for elective open chlecystectomy randomly divided into 2 groups  SA group received spinal anesthesia (SA) using 3.00 ml to 3.5 ml of 0.5% hyperbaric Bupivacane intrathecally and GA group received propofol, Fentanyl Citrate, Atracurium and Halothane during open Cholecystectomy. Other drugs used only to manage anxiety, pain, nausea and vomiting, respiratory complication and for haemodynamic stability. All open chlolecystectomy performed by right oblique incision. Intraoperative and postoperative events were observed for 2 days. Main points of study were. Intraoperative complications (Hypotension, bradycardia, Nausea/Vomiting Breathing Difficulty, Patients and Surgeons satisfactions), Post-operative painfree interval, PONV and requirement of analgesia.

Result: 200 patients with diagnosed cholelithiasis for open chlecystectomy admitted from july2016 to December 2017 in which 150 patients received adequate spinal anesthesia and 50 patients were preferred for GA. INTRA-operatively in SA group 18 patients suffered from respiratory difficulty which was relieved by 100% O2 with ventimask, 39 patients presented with hypotension managed by given injection Mephentermine, only 2 patients received injection Ephidrine, 12 patients presented with nausea and vomiting treated with antiemetic(Injection Ondensetron), 22 experienced pain, injection tramadol was given for pain relief. Post-operatively: Both groups of patients were observed for pain free interval and PONV.

Conclusion: Patients undergoing for uncomplicated open Cholecystectomy under spinal-anesthesia is safe and effective technique than G.A. interms of intraoperative events, post-operative analgesia, PONV, cost effective and in view of surgeons and patients satisfaction.

References

  1. Sinha R, Gurwara AK, Gupta SC. Laparoscopic cholecystectomy under spinal anesthesia: a study of 3,492 patients. J Laparoendosc Adv Surg Tech A. 2009:19:323-327.
  2. Koju RB, Dongol Y , Vera R. Effectiveness of Spinal Anaesthesia versus  General Anaesthesia for Open Cholecystectomy. J Nepal Health Res Counc. 2016;14(33):93-8.
  3. Shaikh GS, Shaikh SM, Bhatti Y, Deenari RA, Baloch I, Soomro Q. Risk factors resulting in conversion of laparascopic to open Cholecystectomy. Med Chanl. 2010;16(2):302-5.
  4. Iitomi T, Toriumi S, Kondo A, Akazana T, Nakahara T, Incidene of  nausea and vomiting after Cholecystectomy via laparotomy or laparoscopy.  Masui. 1995;44:1627-31.
  5. Laoutid J et al. Int Surg J. 2017 Apr;4(4):1417-1421.
  6. Gupta A, Gupta K, Gupta PK, Agarwal N, Rastogi B. Efficacy of thoracic epidural anesthesia for laparoscopic cholecystectomy. Anesth Essays Res. 2011;5:138-41.
  7. Yousef GT, Lasheen AE. General anesthesia versus segmental thoracic or conventional lumbar spinal anesthesia for patients undergoing laparoscopic cholecystectomy. Anesth Essays Res. 2012;6:167-73.
  8. Khan MN, Ashraf MN, Khan HD. Spinal anesthesia versus general anesthesia for open cholecystectomy: comparison of postoperative course. Ann Pak Inst. Med Sci. 2013;9:95-8.
  9. F Hussain Talpur K Altaf Taf, Arshad Mahmood Malik, Ahmed Khan Sangrasi, Amir Iqbal Memon, Abdul Aziz Leghari, Jawed Naeem Qureshi. Comparative study of conventional open versus laparoscopic cholecystectomy for symptomatic cholelithiasia. Pak J Med Sci Jan- mar 2011;27(1):33-7.
  10. Zahoor MU, Masroor R, Khurshid T, Azhar R, Yasin MMA. Thoracic epidural anaesthesia for open cholecystectomy. J Coll Physicians Surg   Pak Nov 2011;21(11):654-8.
  11. Muhammad Nazim Khan, Muhammad Naeem Ashraf, Hina Dilruba Khan Consultant Surgeon, Margalla Hospital, taxilla Cantt. Assistant Professor, Wah Medical College, Wah Cantt. Post Graduate Student, Medical unit-1, Holy Family Hospital, Rawalpindi-Ann.Pak.Inst.Med-Sci 2013,9(2):95-98.
  12. Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C, Laparoscopic cholecystectomy under spinal anesthesia: a pilot study. Surg Endosc. 2006;20:580-582.
  13. Sinha R, GurwaraAK, Gupta SC. Laparoscopic  surgery using spinal anesthesia. JSLS, 2008;12:133-138.
  14. Van Zundert AA, Stultiens G, Jakimowicz JJ, Peek D, van der Ham WG, Korsten HH, et al. Laparoscopic cholecystectomy under segmental thoracic spinal anesthesia a feasibility study. Br J Anaesth. 2007;98:682-686.
  15. Pursnani KG, Bazza Y, Calleja M, Mughal MM, Laparoscopic cholecystectomy under epidural anesthesia in patients with chronic respiratory disease, Surg Endosc., 1998;12:1082-1084.
  16. Ahmed S, Boota M, Khan RA, Ishaque M, KhurshidT, Waseem SHM, Post operative analgesia following open cholecystectomy: is intermittent epidural bupivacaine bolus administration more effective then continuous administration? Professional Med J Jul – Sep 2011;18(3):411-7.
  17. Zhang HW, Chen YJ, Cao MH, Ji FT. Laparoscopic cholecystectomy under epidural anesthesia: a retrospective comparison of 100 patients. Am Surg 2012 Jan;78(1):107-10.
  18. Talpur KA, Malik AM, Memon AI, Leghari AA,  Qureshi JN. Comarative study of conventional open versus laproscopic cholecystectomy for symptomatic cholelithiasis. Pak J Med Sci.2011;27:33-7.
  19. Thune A, Appelgren L, Haglind E, Prevention of postoperative nausea and vomiting after cholecystectomy. A prospective randomized study of metoclopramide and transdermal hyoscine. Eur J Sur. 1995;161:265-8.

Corresponding Author

Dr Charan Singh

Consultant Anaesthetist, Department of Anesthesiology, Malkhan Singh District Hospital, Aligarh, Uttar Pradesh, India

Phone: 8279866348, Email: This email address is being protected from spambots. You need JavaScript enabled to view it., This email address is being protected from spambots. You need JavaScript enabled to view it.