Comparative respiratory outcomes of thoracic spinal versus general anesthesia in laparoscopic colorectal surgery: A...

Neuraxial anesthesia (NA), specifically thoracic spinal anesthesia (TSA), offers several theoretical advantages when compared to the General Anesthesia (GA). This retrospective study compares TSA with the gold standard GA in elective colorectal laparoscopic surgery and evaluates the impact on respiratory functions.

The data used in this study were extracted from the medical records of 34 consecutive patients, who had undergone laparoscopic colon resection surgery in Melegnano Hospital-ASST Melegnano Martesana-Italy and had been administered NA or GA. Postoperative lung function was assessed via lung ultrasound [Lung Ultrasound Score(LUS)], and PaO₂/FiO₂ (P/F) ratio.

The average duration of the surgical procedure was 201.9 ± 50.4 min (NA 191.1 ± 44.1 vs. GA 212 ± 55.3 min, P = 0.21). Arterial blood gas parameters showed a reduction in the postoperative values of P/F ratio (P/F: NA 387 ± 70 vs GA 342 ± 52, P = 0.049). LUS reveals a higher prevalence of atelectasis in the poster-inferior lung regions. After surgery, the pre- and post-operative LUS scores (Delta LUS) showed differences in the GA group (NA 1.8 ± 1.8 vs GA 3.8 ± 1.9, P = 0.003). The receiver operating characteristic (ROC) curve proved to be very accurate (area under the curve (AUC) = 0.898, P < 0.001) in predicting postoperative oxygen support, even more so in the GA group (2 in the NA group vs 7 in the GA).

In the context of a progressively aging population and an increase in the fragility of patients, NA with spontaneous ventilation appears to exert a minor impact on respiratory function compared to GA.