Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000300001
Brazilian Journal of Anesthesiology
Scientific Article

Anestesia geral versus raquianestesia para colecistectomia videolaparoscópica

General anesthesia versus spinal anesthesia for laparoscopic cholecystectomy

Luiz Eduardo Imbelloni; Marcos Fornasari; José Carlos Fialho; Raphael Sant'Anna; José Antonio Cordeiro

http://dx.doi.org/10.1590/S0034-70942010000300001 Braz J Anesthesiol, vol.60, n3, p.217-227, 2010
PDF Português
PDF English
Downloads: 0
Views: 1138

Resumo

JUSTIFICATIVA E OBJETIVOS: A colecistectomia laparoscópica é o tratamento de escolha para a litíase biliar. Este estudo foi idealizado para comparar a possibilidade de se realizar colecistectomia laparoscópica sob raquianestesia comparando com anestesia geral. MÉTODO: Entre julho 2007 e setembro 2008, 68 pacientes com sintomas de cálculo na vesícula foram incluídos no estudo. Pacientes com estado físico ASA I e II foram aleatoriamente separados para serem operados de colecistectomia laparoscópica com pneumoperitônio com baixa pressão de CO2 sob anestesia geral (n = 33) ou raquianestesia (n = 35). A anestesia geral foi realizada com propofol, fentanil, rocurônio, sevoflurano e intubação traqueal. A raquianestesia foi realizada com 15 mg de bupivacaína hiperbárica com 20 µg fentanil até que o nível sensitivo atingisse T3· Parâmetros intraoperatórios, dor pós-operatória, complicações, recuperação, satisfação do paciente e custo foram comparados entre os grupos. RESULTADOS: Todos os procedimentos cirúrgicos foram completados com o método de escolha e apenas um paciente foi convertido da raquianestesia para a anestesia geral. A dor foi significativamente menor a 2, 4 e 6 horas após o procedimento sob raquianestesia comparado com o grupo que recebeu anestesia geral. O custo da raquianestesia foi significativamente menor. Todos os pacientes foram liberados após 24 horas. Na avaliação no pós-operatório, todos os pacientes ficaram satisfeitos com a raquianestesia e recomendariam esse procedimento. CONCLUSÕES: A colecistectomia laparoscópica com pneumoperitônio com baixa pressão de CO2 pode ser realizada com segurança sob raquianestesia. A raquianestesia foi associada a mínima dor pós-operatória, melhor recuperação e menor custo do que anestesia geral.

Palavras-chave

ANESTESIA, CIRURGIA, CIRURGIA, TÉCNICA ANESTÉSICA

Abstract

BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The objective of this study was to compare the possibility of performing laparoscopic cholecystectomy under spinal anesthesia versus general anesthesia. METHODS: Between July 2007 and September 2008, 68 patients with symptoms of cholelithiasis were included in this study. Patients with physical status ASA I and II were randomly divided to undergo laparoscopic cholecystectomy with low-tension pneumoperitoneum with CO2 under general anesthesia (n = 33) or spinal anesthesia (n = 35). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for general anesthesia. Hyperbaric bupivacaine 15 mg, and fentanyl 20 µg to achieve a sensorial level of T3· were used for the spinal anesthesia. Intraoperative parameters, postoperative pain, complications, recovery, patient satisfaction, and cost were compared between both groups. RESULTS: All surgical procedures were completed with the chosen method and spinal anesthesia was converted to general anesthesia only in one patient. Pain was significantly lower at 2, 4, and 6 hours after the procedure under spinal anesthesia. The cost of the spinal anesthesia was significantly lower than that of the general anesthesia. All patients were discharged after 24 hours. In the postoperative evaluation, all patients were satisfied with the spinal anesthesia and would recommend this procedure. CONCLUSIONS: Laparoscopic cholecystectomy with low-pressure pneumoperitoneum with CO2 can be safely performed under spinal anesthesia. Spinal anesthesia was associated with an extremely low level of postoperative pain, better recovery, and lower cost than general anesthesia.

Keywords

subaracnoidea, ANESTHESIA, ANESTHETIC TECHNIQUE, ANESTHETIC TECHNIQUE, SURGERY, SURGERY

References

Soper NJ, Stockman PT, Dunnegan DL. Laparoscopic cholecystectomy: the new "gold standard"?. Arch Surg. 1992;127:917-921.

Reddick EJ, Olsen DO. Laparoscopic laser cholecystectomy: a comparison with mini-lap cholecystectomy. Surg Endosc. 1989;3:131-133.

Gramatica Jr L, Brasesco OE, Mercado Luna A. Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surg Endosc. 2002;16:472-475.

Hamad MA, El-Khattary OA. Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study. Surg Endosc. 2003;17:1426-1428.

van Zundert AAJ, Stultiens G, Jakimowics JJ. Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease. Br J Anaesth. 2006;96:464-466.

Pursnani KG, Bazza Y, Calleja M. Laparoscopic cholecystectomy under epidural anesthesia in patients with chronic respiratory disease. Surg Endosc. 1998;12:1082-1084.

Rodgers A, Walker N, Schug S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trial. Br Med J. 2000;321.

Standl T, Eckert S, Schulteam Esch J. Postoperative complaints after spinal and thiopentone-isoflurane anesthesia in patients undergoing orthopaedic surgery: Spinal versus general anaesthesia. Acta Anaethesiol Scand. 1996;40:222-226.

Tzoravaras G, Fafoulakis F, Pratsas K. Laparoscopic cholecystectomy under spinal anesthesia: a pilot study. Surg Endosc. 2006;20:580-582.

Yuksek YN, Akat AZ, Gozalan U. Laparoscopic cholecystectomy under spinal anesthesia. Am J Surg. 2008;195:533-536.

Ben-Haim M, Rosenthal RJ. Causes of arterial hypertension and splachnic ischemia during acute elevations in intra-abdominal pressure with CO2 pneumoperitoneum: a complex central nervous system mediated response. Int J Colorectal Dis. 1999;14:227-236.

Gebhardt H, Bautz A, Ross M. Pathophysiological and clinical aspects of the CO2 pneumoperitoneum (CO2-PP). Surg Endosc. 1997;11:864-867.

Kotzampassi K, Kapanidis N, Kazamias P. Hemodynamic events in the peritoneal environment during pneumoperitoneum in dogs. Surg Endosc. 1993;7:494-499.

Gandara V, de Vega DS, Escriu N. Acid-base balance alterations in laparoscopic cholecystectomy. Surg Endosc. 1997;11:707-710.

Junghans T, Bohm B, Grundel K. Effects of pneumoperitoneum with carbon dioxide, argon, or helium on hemodynamic and respiratory function. Arch Surg. 1997;132:272-278.

Tzovaras G, Fafoulakis F, Pratsas K. Spinal vs general anesthesia for laparoscopic cholecystectomy: interim analysis of a controlled randomized trial. Arch Surg. 2008;143:497-501.

So JB, Cheong KF, Sng C. Ondansetron in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospectivr randomized study. Surg Endosc. 2002;16:286-288.

McLeod GA, Dell K, Smith C. Measuring the quality of continuous epidural block for abdominal surgery. Br J Anaesth. 2006;96:633-639.

Sinha R, Gurwara AK, Gupta SC. Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A. 2009;19:323-327.

5dd2da530e8825e604c63494 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections