Non-intubated Ambulatory Anaesthesia for Diagnostic gynaecological laparoscopy

General endotracheal relaxant anaesthetic technique is favoured for laparoscopic gynaecological procedures, in order to prevent inadequate ventilation, regurgitation and aspiration resulting from pneumoperitoneum and steep trendelenburg position during the procedure. However, simple brief laparoscopic procedures have been performed safely over the years in adult population using alternative airway devices. We report our experience over a fifteen-year period, of using general anaesthesia by face mask ventilation for short diagnostic laparoscopy in gynaecologic practice.

A retrospective, cross- sectional observational study involving 823 consecutive elective patients for diagnostic gynaecological laparoscopic procedures. The 823 patients were classified as American society of Anesthesiologists (ASA) I or II patients and were studied over the fifteen year period. They were all premedicated with atropine & metoclopramide after overnight fast, and had general anaesthesia by facemask with assisted ventilation; using thiopentone for induction, paracetamol & piroxicam for analgesia and oxygen-halothane via Bain's breathing circuit for maintenance. Monitoring procedures employed in this study included pulse rate (PR), non-invasive blood pressure (NIBP) and oxygen saturation (SPO2).

Out of a total of 823 patients studied, majority (93.8%) of the patients were investigated for infertility. The mean duration for the procedure was 18.2±2.5 minutes. The complications observed included post-operative nausea and vomiting in 58(7.0%) of the patients, regurgitation & desaturation in 2(0.2%) of patients each, while laryngeal spasm & colonic insufflations each occurred in 1(0.1%) patient. Three patients (0.3%) had unplanned admission for observation overnight. There was no case of mortality.

General anaesthesia by facemask ventilation is a safe alternative to endotracheal intubation for short diagnostic gynaecological laparoscopy when fasting guidelines are observed.