Anesthesia for Laparoscopic Cholecystectomy: Experience with 5000 Cases

Abstract

Background: Since the introduction of laparoscopic cholecystectomy in 1987 by Philips Mouret its popularity has increased tremendously and very rapidly because of its several advantages. But reports of randomized large control seriesare not yet available so we plan to report our experience of 5000 cases of single incision laparoscopic cholecystectomies and their anesthetic management. Objective: The purpose of this retrospective study was to evaluate the general anesthetic technique for laparoscopic cholecystectomy keeping in mind the pathophysiological effect of laparoscopy, head up position and pneumoperitoneum. Methods: A retrospective study of 5000 cases of symptomatic gall bladder disease that underwent laparoscopic cholecystectomy at Nobel Medical College Teaching Hospital, Nepal from Jan 2010-Dec 2015 was done. Detail pre-anesthetic check up, investigation, preparation and anesthetic techniques were carried out as per hospital protocol. Strict vigil was made to maintain the vital parameters within normal limit particularly ETCO2 below 35 mmHg. All efforts were made to keep ETCO2 below 35mHg. At the end of surgery residual neuromuscular blockade was reversed with neostigmine and glycopyrrolate, before they were transferred to PACU. Results: The mean age of the patients was 48 years with a male:female of 1:2.26. 28.64 % of patients belonged to ASA III. More than 95 % patients maintained SPO2 between 98-100% and 91% maintained their ETCO2 below or around 35 mmHg. Intra-operative surgical and anesthetic complications were controlled with proper therapies. There was no intra-operative death. Conclusion: Single incision laparoscopic Cholecystectomy (SILC) is a safe, cost effective ideal for day care surgery and general anesthesia with controlled mechanical ventilation with oxygen, air, fentanyl, isoflurane, midazolam and vecuronium/atracurium is good choice.

Efficacy and opioid-sparing effect of interpleural bupivacaine in patients undergoing laparoscopic cholecystectomy: Prospective observational study (Running title: Efficacy of inter-pleural bupivacaine in laparoscopy)

“…The incidence of intra-and post-operative complications like dizziness, nausea, vomiting, and length of hospital stay (3.5 days) was less in group 1 than group 2. Similar findings were reported in the study of 5000 patients, with lower incidence of intra-and post-operative complications, and 92.5% of patients discharged by post-operative day 3 16 . Lower consumption of opioid in patients with interpleural analgesia.…”

Experience in laparoscopic cholecystectomy in Nobel Medical College, Nepal

“…Detail pre-anesthetic check up, investigations, preparation and anesthetic techniques were carried out as per hospital protocol. We maintain the vital parameters within limits particularly ETCO2 below 35 mmHg (19). LC was initiated in all cases with consent for conversion to open surgery or laparoscopic CBD exploration whenever necessary and intraoperative cholangioscopy with stone removal was done.…”