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Experience of Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-pressure Pneumoperitoneum - Prospective Study of 300 Cases

INTRODUCTION: Having long experience of open upper abdominal surgery under spinal anesthesia and laparoscopic cholecystectomy under general anesthesia, we performed this study of laparoscopic cholecystectomy with low-pressure pneumoperitoneum under spinal anesthesia to assess its safety and feasibil...

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Autores principales: Kar, Manoranjan, Kar, Jugal K., Debnath, Bibhas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122092/
https://www.ncbi.nlm.nih.gov/pubmed/21546725
http://dx.doi.org/10.4103/1319-3767.80385
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author Kar, Manoranjan
Kar, Jugal K.
Debnath, Bibhas
author_facet Kar, Manoranjan
Kar, Jugal K.
Debnath, Bibhas
author_sort Kar, Manoranjan
collection PubMed
description INTRODUCTION: Having long experience of open upper abdominal surgery under spinal anesthesia and laparoscopic cholecystectomy under general anesthesia, we performed this study of laparoscopic cholecystectomy with low-pressure pneumoperitoneum under spinal anesthesia to assess its safety and feasibility. MATERIALS AND METHODS: In a private rural health set-up, 300 patients were selected prospectively for laparoscopic cholecystectomy under low-pressure (8 mm) pneumoperitoneum under spinal anesthesia in a span of three years. Only 3.5 ml of 0.5% bupivacaine was used for spinal anesthesia. Fourth port positioned at lower than usual at the level of umbilicus, change of position of the table with different stages of operation, massaging of right shoulder in cases of shoulder pain, removal of smoke if formed during dissection to diminish shoulder pain and holding the body of the gallbladder by the fourth port grasper at the level of lower margin of the liver in cases of long gallbladder were some modifications of standard laparoscopic cholecystectomy made in this study. RESULTS: We successfully performed the operations in 291 patients without major complications. Four patients denied operation under spinal anesthesia. Spinal anesthesia was converted to general anesthesia in two patients due to severe shoulder pain. The operation was converted to open cholecystectomy in three patients. Mean age was 34.6 years (range 21-82 years). Mean BMI was –23.1 (range 20.8-28.3). Mean duration of operation was 39.6 min (range 18-78 min). Mean O(2) saturation was 97.6%. Mean peak respiratory rate was 23.4 (range 16-38). 90.08% patients complained of right shoulder pain – most of them managed by shoulder massage alone. All patients were satisfied on follow up. CONCLUSION: Laparoscopic cholecystectomy under spinal anesthesia with low-pressure pneumoperitoneum can be performed safely and satisfactorily without major complications by experienced surgeons.
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spelling pubmed-31220922011-07-01 Experience of Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-pressure Pneumoperitoneum - Prospective Study of 300 Cases Kar, Manoranjan Kar, Jugal K. Debnath, Bibhas Saudi J Gastroenterol Original Article INTRODUCTION: Having long experience of open upper abdominal surgery under spinal anesthesia and laparoscopic cholecystectomy under general anesthesia, we performed this study of laparoscopic cholecystectomy with low-pressure pneumoperitoneum under spinal anesthesia to assess its safety and feasibility. MATERIALS AND METHODS: In a private rural health set-up, 300 patients were selected prospectively for laparoscopic cholecystectomy under low-pressure (8 mm) pneumoperitoneum under spinal anesthesia in a span of three years. Only 3.5 ml of 0.5% bupivacaine was used for spinal anesthesia. Fourth port positioned at lower than usual at the level of umbilicus, change of position of the table with different stages of operation, massaging of right shoulder in cases of shoulder pain, removal of smoke if formed during dissection to diminish shoulder pain and holding the body of the gallbladder by the fourth port grasper at the level of lower margin of the liver in cases of long gallbladder were some modifications of standard laparoscopic cholecystectomy made in this study. RESULTS: We successfully performed the operations in 291 patients without major complications. Four patients denied operation under spinal anesthesia. Spinal anesthesia was converted to general anesthesia in two patients due to severe shoulder pain. The operation was converted to open cholecystectomy in three patients. Mean age was 34.6 years (range 21-82 years). Mean BMI was –23.1 (range 20.8-28.3). Mean duration of operation was 39.6 min (range 18-78 min). Mean O(2) saturation was 97.6%. Mean peak respiratory rate was 23.4 (range 16-38). 90.08% patients complained of right shoulder pain – most of them managed by shoulder massage alone. All patients were satisfied on follow up. CONCLUSION: Laparoscopic cholecystectomy under spinal anesthesia with low-pressure pneumoperitoneum can be performed safely and satisfactorily without major complications by experienced surgeons. Medknow Publications 2011 /pmc/articles/PMC3122092/ /pubmed/21546725 http://dx.doi.org/10.4103/1319-3767.80385 Text en © Saudi Journal of Gastroenterology http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kar, Manoranjan
Kar, Jugal K.
Debnath, Bibhas
Experience of Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-pressure Pneumoperitoneum - Prospective Study of 300 Cases
title Experience of Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-pressure Pneumoperitoneum - Prospective Study of 300 Cases
title_full Experience of Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-pressure Pneumoperitoneum - Prospective Study of 300 Cases
title_fullStr Experience of Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-pressure Pneumoperitoneum - Prospective Study of 300 Cases
title_full_unstemmed Experience of Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-pressure Pneumoperitoneum - Prospective Study of 300 Cases
title_short Experience of Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-pressure Pneumoperitoneum - Prospective Study of 300 Cases
title_sort experience of laparoscopic cholecystectomy under spinal anesthesia with low-pressure pneumoperitoneum - prospective study of 300 cases
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122092/
https://www.ncbi.nlm.nih.gov/pubmed/21546725
http://dx.doi.org/10.4103/1319-3767.80385
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