Anaesthesia Concern in High-Risk Cases Under-Going Ambulatory Laparoscopic Cholecystectomy

Abstract

Objective:To evaluate pre-operative implications, anesthetic management and post-operative anesthetic concerns in patientswith co-morbid diseases undergoing ambulatory laparoscopic cholecystectomy under general anesthesia. Study Design and setting:Retrospective study was conducted at Rawal Institute of Health Sciences, Islamabad from 8thOct 2017 to 5th Nov 2018. Methodology:Total one hundred and twelve patients were placed in American society of Anaesthesiologist (ASA) classII, III & IV (medically optimized) on pre-operative evaluation for ambulatory laparoscopic cholecystectomy. Generalanesthesia was administered with co-induction (nalbuphine 0.1mg/kg plus midazolam 0.01mg/kg) tracheal intubationfacilitated by 0.15mg/kg cis-atracurium. Post-operatively on clinical status evaluation and Post Anesthesia Discharge score,patients were shifted to respective ward /intensive care. Statistical analysis was done by SPSS v.21. Results:Pre-operatively medical and cardiologist evaluation was taken in 34(30.35%) and 42(37.5%) cases respectivelywhereas consultant anesthesiologist reviewed all cases. In study single case was converted to open method due to mirrizisyndrome and adhesions creating difficult laparoscopic dissection in 9(8.03%) of cases. Post-operatively in single caseatrial fibrillation with fast ventricular response noted followed by sudden bradycardia, managed and sinus rhythm restored,whereas in other case of ischemic heart disease with viral respiratory infection, needed ventilatory support after 2 hoursdue to respiratory distress and weaned off after 24hrs. In the study 76(67.9%) cases were shifted post-operatively to surgical ward and 36 cases (32.1%) needed intensive care treatment. Conclusion:Laparoscopic cholecystectomy in patients with co-morbid states requires balanced anesthetic technique considering consequences of pneumoperitoneum to decrease morbidity.

Effect of Anti-Emetic Combination of Sevoflurane / Propofol Anesthesia Technique in Laparoscopic Cholecystectomy

“…18 Keeping intra-abdominal pressure (kept below 10 cm H2O in all cases of study) is stated as an important factor in reducing frequency of post-operative nausea. 9 In study done by Gautam B 19 and colleagues they pointed out that combination of ondansetron with dexamethasone was more effective (regimen used in our study) as a prophylactic against nausea / vomiting in laparoscopically removal of gallbladder as compared to both drugs alone.…”

“…4 It is sweet smelling volatile anesthetic, non-irritant with rapid onset, delivers optimal hemodynamic stability. 4,8,9 Propofol is also a frequently employed intravenous anesthetic induction agent. 8,9 Fredman B 10 , et al did a study comparing three different anesthetic techniques in day-case surgery including sevoflurane, propofol, they stated that sevoflurane is a appropriate substitute to propofol as part of balanced anesthesia agent in ambulatory surgery cases.…”

“…4,8,9 Propofol is also a frequently employed intravenous anesthetic induction agent. 8,9 Fredman B 10 , et al did a study comparing three different anesthetic techniques in day-case surgery including sevoflurane, propofol, they stated that sevoflurane is a appropriate substitute to propofol as part of balanced anesthesia agent in ambulatory surgery cases. Keeping in view above consideration this study was configured to assess frequency of nausea and vomiting post-operatively (at 24 hours interval) employing diverse anesthesia induction modalities (propofol and sevoflurane 9 ) in laparoscopic cholecystectomy keeping anesthesia maintenance methods same and employing anti-emetic regimen combination (dexamethasone and ondansetron) can address the issue of post-operative nausea and vomiting.…”

“…8,9 Fredman B 10 , et al did a study comparing three different anesthetic techniques in day-case surgery including sevoflurane, propofol, they stated that sevoflurane is a appropriate substitute to propofol as part of balanced anesthesia agent in ambulatory surgery cases. Keeping in view above consideration this study was configured to assess frequency of nausea and vomiting post-operatively (at 24 hours interval) employing diverse anesthesia induction modalities (propofol and sevoflurane 9 ) in laparoscopic cholecystectomy keeping anesthesia maintenance methods same and employing anti-emetic regimen combination (dexamethasone and ondansetron) can address the issue of post-operative nausea and vomiting. Hence, the primary objective was to assess symptoms of nausea and vomiting in laparoscopic cholecystectomy post-operatively in 24 hours interval after surgery by administering anesthesia of sevoflurane or propofol and to assess the effect of dexamethasone and ondansetron as an anti-emetic combination.…”

“…21,22 In another study, comparing single antiemetic use(ondansetron) with combination therapy (ondansetron with dexamethasone) for efficacy against postop nausea and vomiting, in laparoscopic gall stones surgery, they reported dual anti-emetic showing better results, in this study two combination medications were will come utilized with promising results 23 . Another study, employed balanced anesthesia technique gallstones laparoscopic surgery in patients with co-morbid diseases 24 along with anti-emetic combination (regimen used in this study) with good effect.…”