Evaluation of Laparoscopic Procedures under Low-Pressure Pneumoperitoneum And Regional Anesthesia

Asem Elsani M.A. Hassan1, MD, Omar Abdel-Raheem1, MD, Ahmed Abd-ElMaboud2, MD, Mostafa Abd Allateef1, MS

1 Department of General Surgery, Faculty of Medicine, Sohag University.

2 Department of Anaesthesia, Faculty of Medicine, Sohag University.

BACKGROUND The development of laparoscopic surgery has revolutionized surgical procedures and thus has influenced the practice and techniques of anaesthesia.

OBJECTIVE The aim of this work was to assess the feasibility and safety of laparoscopic procedures in adult patients (ASA score I or II) under low-pressure CO2 pneumoperitoneum and regional anaesthesia.

RESULTS This prospective study was conducted at surgery department, Sohag university hospital, from December 2014 to March 2016. Twenty two patients underwent different laparoscopic procedures (14 LC , 6 lap varicocelectomy and 2 lap appendectomy), 20 of them (90.9%) completed the procedure under spinal anaesthesia and low pneumoperitoneum pressure at 8-12 mm Hg and 2 (9.1%) were converted to general anaesthesia. Rank of technical difficulty was determined by the surgeon by giving number over five and it ranged from 2/5 in 16 cases (80%) to 4/5 in one case (5%).Overall operative and anaesthesia times ranged from 30 to 60 minutes (Mean 36.5 + 7.96 min.) and 45 to 75 minutes (Mean 51.5 + 7.96 min.) respectively, but it differed according to the type of surgical procedure. No intraoperative complications and none of the patients was converted to open surgery. The vitals were maintained at a normal range. Mean arterial pressure ranged from 86.6 to 100 (Mean 93.8+4.8). The maximum respiratory rate during pneumoperitoneum ranged from 16 to 26 per minute (Mean 19 + 3.8).

Conclusion Laparoscopic procedures under regional anesthesia with low-pressure pneumoperitoneum are safe and feasible. Its advantages over general anaesthesia include uniform total muscle relaxation, a conscious patient, economical, relatively uneventful recovery, pain free early postoperative period and the protection from potential complications of general anaesthesia.

Key Words Laparoscopic procedures, Low-pressure pneumoperitoneum.

PRESENTING Author Mostafa Abd Allateef Muhammed , Department of General Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt.