Combined spinal and general anesthesia is better than general anesthesia alone for laparoscopic hysterectomy

Abstract

Context:Spinal anesthesia (SA) was combined with general anesthesia (GA) for achieving hemodynamic stability in laparoscopic hysterectomy.Aims:The aim of our study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability in laparoscopic hysterectomy. The secondary outcomes studied were requirement of inhaled anesthetics, vasodilators, and recovery profile.Settings and Design:We conducted a prospective, randomized study in ASAI/II patients posted for laparoscopic hysterectomy, who were willing to participate in the study.Materials and Methods:Patients were randomly assigned to receive SA with GA (group SGA) or plain GA (group GA). Group SGA received 10 mg bupivacaine (heavy) for SA. GA was administered using conventional balanced technique. Maintenance was carried out with nitrous oxide, oxygen, and isoflurane. Comparison of hemodynamic parameters was carried out during creation of pneumoperitoneum and thereafter. Total isoflurane requirement, need of vasodilators, recovery profile, and regression of SA were studied.Statistical analysis used:Descriptive statistics in the form of mean, standard deviation, frequency, and percentages were calculated for interval and categorical variables, respectively. One-way analysis of variance (ANOVA) was applied for noting significant difference between the two groups, with chi-square tests for categorical variables and post-hoc Bonferroni test for interval variables. Comparison of heart rate (HR), mean arterial pressure (MAP), SPO2, and etCO2 was done with Student's t-test or Mann–Whitney test, wherever applicable.Results:Patients in group SGA maintained stable and acceptable MAP values throughout pneumoperitoneum. The difference as compared to group GA was statistically significant (P < 0.01). Group GA showed additional requirement of metoprolol (53.33%) and higher concentration of isoflurane (P < 0.001) to combat the increased MAP. Recovery was early and quick in group SGA as against group GA (P = 0.000). There were no adverse/residual effects of SA.Conclusion:The hemodynamic repercussions during pneumoperitoneum can be effectively attenuated by combining SA and GA, without any adverse effects.

Effect of intrathecal buprenorphine on the haemodynamic response in patients undergoing laparoscopic appendicectomy under general anaesthesia

“…Poonam S. Ghodki et al compared the effect of 10mg bupivacaine heavy intrathecally along with general anaesthesia alone for laparoscopic hysterectomy. It was found that a statistically significant rise in mean arterial blood pressure (113.40 ± 4.06 v/s 92.42 ± 2.72, p=0.001) 12 continued throughout pneumoperitoneum when general anaesthesia only was given. After the release of pneumoperitoneum, the difference was not statistically significant and blood pressure values were within 20% of baseline.…”

Comparison of the effect of general anesthesia and spinal anesthesia technique combined with general anesthesia on intraabdominal volume during gynecological laparoscopy

“…Previous studies were based on subjective survey studies 8 . In this study, we performed an objective study by calculating anthropometric measurements and intra‐abdominal volumes.…”

“…7 In a subjective evaluation of surgeons in a study showing the curative effect of SA combined with GA on hemodynamic parameters, it has been observed that a better operating area is formed by contracting the intestines and pulling them upward as a result of the increase in parasympathetic activity following SA. 8 In this study, our assumption was that as a result of the sympathectomy effect of SA to be performed simultaneously with GA, we would obtain a wider operation area with the same pressure with a decrease in muscle tone and pulling the intestines up. Moreover, we wanted to demonstrate this by making anthropometric measurements and calculating the volume of intra-abdominal insufflated CO 2 .…”

Comparison between Combination of Spinal and General Anesthesia with Plain General Anesthesia in Patients Undergoing Laparoscopic Gynaecological Surgeries

“…SA alone is being successfully utilized for short or day care laparoscopic procedures. For major laparoscopic surgeries, however, conventional GA is still the technique of choice [16] . But under GA, the hemodynamic derangements during pneumoperitoneum have to be managed by either increasing the anesthetic concentration or by administering vasodilators [17,18] .…”