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Experience of Laparoscopic Cholecystectomy Under Thoracic Epidural Anaesthesia: Retrospective Analysis of 96 Patients
Murat Bilgi1, Esin Erkan Alshair2, Hüseyin Göksu2
1Department of Anaesthesiology and Reanimation, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey.
Objective:
Although the traditional anaesthesia method for laparoscopic cholecystectomy has been general anaesthesia, regional anaesthesia techniques are also successfully used today. In this paper, we aimed to report our experiences with thoracic epidural anaesthesia, including complications, postoperative analgesia, technical difficulties and side effects.
Methods:
Between December 2009 and November 2012, 90 patients undergoing laparoscopic cholecystectomy were retrospectively analysed. Demographic data, American Society of Anesthesiologists (ASA) scores, comorbidities, duration of operations, medications and doses used for sedation were reviewed.
Results:
The gender distribution of patients were recorded as 15 males (15%) and 81 females (85%). The patients had an average age of 46.74±13.28, an average height of 162.50±5.57 cm and a mean weight of 73.57±12.48 kg. ASA classifications were distributed as follows: ASA I: 63 (65%) patients, ASA II 28 (29%) patients and ASA III: 5 patients. We recorded 3 patients with chronic obstructive pulmonary disease (COPD), 14 patients with diabetes mellitus (DM) and 22 patients with hypertension who got their diagnosis in the perioperative visit. During the operation, three patients had bradycardia (heart rate 50 min(-1)), and atropine was applied. Ephedrine and fluid resuscitation had been applied to 3 patients for the treatment of intraoperative hypotension. Midazolam, ketamine hydrochloride and propofol were administered to patients for sedation during the operations. Thoracic epidural anaesthesia was performed at the level of T7 -9 intervertebral space with the patients in the sitting position. Patients were given oxygen by a face mask at a rate of 3-4 L min(-1). The pneumoperitoneum was created by giving carbon dioxide at the standard pressure of 12 mmHg into the abdominal cavity in all patients. If needed, postoperative analgesia was provided by epidural local anaesthetic administration.
Conclusion:
Thoracic epidural anaesthesia can be applied as an alternative to general anaesthesia for laparoscopic cholecystectomy.
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