Resum
Background: Laparoscopy is now readily being deployed for abdominal surgeries in our centre, thanks to the surgeons´interest and the desire to follow best practice as obtained in other climes. General anaesthesia (GA) with intermittent positive pressure ventilation is usually the preferred mode of anaesthesia for this procedure. There are reports of laparoscopic surgery of abdomen performed under spinal and or epidural anaesthetic techniques.
Methods: With Intra-Abdominal Pressure (IAP) from CO2 insufflations limited to 10-12mmHg, Laparoscopic Appendicectomy (LA) was performed under Combined Spinal Epidural (CSE) for ten consenting ASA 1and II patients with mean age 23.6 years and BMI of 24.9kg/m2 in University College Hospital Ibadan, Nigeria. Intraoperative events and ease of operation were studied; systemic drugs were administered if patients complained of pain and discomfort, and G.A if regional techniques and sedation failed.
Results: Eight(8)patients had the procedure completed under spinal anaesthesia supplemented with sedation, two (2) patients whose block went as high as T4 had no need of sedation. There were operative difficulties in four patients out of which 2 had sedations and the surgeons could continue operating. We converted to GA in two (2) patients when regional techniques and sedation failed.
Conclusion: We concluded that with proper selection of patients and limiting IAP to 10-12mmHg, LA can be safely performed with spinal anaesthesia with some supplementation.
Keywords: Regional anaesthetic techniques, Epidural, Spinal, Laparoscopic abdominal surgery, Laparoscopic appendicectomy, sedation.
Résumé
Introduction : La laparoscopie est maintenant aisément déployée pour les chirurgies abdominal dans notre centre, grâces a l’intérêt et désire des chirurgiens à suivre les la pratique meilleure comme obtenue dans les autres régions. L’anesthésie générale (AG) avec pression positive de ventilation intermittente est usuellement la mode d’anesthésie préférée pour cette procédure. Il ya des rapports de chirurgie de l’abdomen à laparoscopie exécutées sous des techniques anesthétiques dorsale et ou épidurale.
Méthode : Avec la Pression Intra-Abdominal (PIA) des insufflations du CO2 limitées à 10-12mmHg, l’Appendicectomie à Laparoscopie (AL) était exécutée sous une Coalition Spinale Epidurale (CSE) pour dix patients ASA 1 et 2 (sous accords) avec un âge moyen de 23,6 ans et BMI 24,9kg/m2 au Collège Hospitalier Universitaire (CHU), Ibadan, Nigeria. Les issues intra-opérative et aisance d’opération étaient étudiées; des drogues systémiques étaient administrées si les patients se plaignaient de douleur et déconfort, et AG si les techniques régionales et sédation échouaient.
Résultats : Huit (8) patients avaient la procédure achevée sous l’anesthésie spinale supplémentée avec sédation, deux (2) patients dont les bloques sont allées aussi haut que T4 n’avaient pas besoin de sédation. Il y avait des difficultés opérative dans quatre patients parmi ou 2 avaient sédations et les chirurgiens pouvaient continuer à opérés. Nous avons converti à l’AG dans deux (2) patients quand les techniques régionales et sédation ont échouées.
Conclusion : Nous avons conclu qu’avec une propre sélection de patients et en limitant PIA à 10-12mmHg, AL peut être sûrement exécuté avec l’anesthésie spinale avec certain supplémentassions.
Mots clés : Techniques d’anesthésie régionales, Epidurale, Spinale, Chirurgie abdominale à laparoscopie, Appendicectomie à laparoscopie, Sédation.
Correspondence: Dr. R.P. Olonisakin, Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria, Email:polonisakin@gmail.com/rolonisakin@gmail.com
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