Comparing laparoscopic cholecystectomy in patients with chronic obstructive pulmonary disease under spinal anesthesia and general anesthesia

Abstract

BackgroundEpidemiological data demonstrate that the worldwide prevalence of chronic obstructive pulmonary disease is increasing. These patients have an increased risk of mortality and morbidity and have constant limitations in airflow. Comparing laparoscopic cholecystectomy (LC) in patients with chronic obstructive pulmonary disease (COPD) under spinal anesthesia (SA) and general anesthesia (GA).MethodsWe prospectively evaluated COPD patients who underwent laparoscopic cholecystectomy under general anesthesia (Group 1, n = 30) or spinal anesthesia (Group 2, n = 30) in our clinic between January 2016 and January 2018. Patients with COPD were further divided into groups according to their preoperative stages (Stage 1–4). Intraoperative vital findings, postoperative pain, complications, and length of hospitalization were compared between the general (GA) and spinal anesthesia (SA) groups.ResultsThe mean age of the patients in the GA group was 61.0 ± 6.7 years and was 61.0 ± 7.7 years in the SA group. In the GA and SA groups, the mean ASA score was 2.8 ± 0.6 and 2.9 ± 0.6, respectively, the mean operation duration was 31.7 ± 5.1 and 30.6 ± 5.1 min, respectively, and the length of hospitalization was 3.2 ± 1.7 and 1.5 ± 0.5 days, respectively. The partial carbon dioxide rates (PaCO2) at the postoperative 5th and 20th minutes were lower in the SA group than in the GA group. Further, the requirement for postoperative analgesia was lower in the SA group, and the length of hospitalization was significantly shorter in the SA group. There was no significant difference between the two groups in terms of operation duration.ConclusionLaparoscopic cholecystectomy is a rather safe procedure for COPD patients under general and spinal anesthesia. However, spinal anesthesia is preferred over general anesthesia as it has better postoperative analgesia and causes no impairment of pulmonary functions.Electronic supplementary materialThe online version of this article (10.1186/s12893-018-0396-1) contains supplementary material, which is available to authorized users.

Laparoscopic cholecystectomy with thoracic epidural anesthesia and low pressure pneumoperitoneum in patients with chronic obstructive pulmonary disease: A retrospective study

“…In the literature, shoulder pain requiring additional analgesia has been reported between 10% and 55%. [1,5,6,16] Consistently with the literature, in our study 12 (35.3) patients developed shoulder pain, with 7 (20.6%) of them required analgesics.…”

“…Epidural anesthesia enables performing the surgery without disrupting mucociliary activity, and moreover it reduce respiratory difficulty because of the decreased postoperative pain. [5,6,15] In our study, analgesic was needed in 13 (38.2%) patients at the 6 th hour, 3 (8.8%) patients had a VAS score requiring analgesics. None of our patients required analgesics at the 24 th hour.…”

“…Previous studies have found significantly higher postop PCO 2 level compared to pre-op PCO 2 level in patients undergoing laparoscopic cholecystectomy under general anesthesia. [13,14] Bayrak et al [6] found that while there was no significant difference between COPD patients who underwent laparoscopic cholecystectomy under general or spinal anesthesia in terms of PCO 2 at the pre-op 5 th and 20 th minutes, PCO 2 values at the post-op 5 th and 20 th minutes were lower with spinal anesthesia.…”

“…With epidural anesthesia, both mucociliary activity is protected and lower post-op pain positively affect respiratory functions. [4][5][6] In this study, we retrospectively reviewed our results of laparoscopic cholecystectomy that we performed under epidural anesthesia in ASA III-IV patients with restricted respiratory functions due to COPD.…”

Comparison of Efficacy of Combined Spinal-Epidural Anaesthesia With General Anaesthesia in Patients Undergoing Laparoscopic Cholecystectomy

“…[24] Further in a study by Bayrak et al by comparing GA vs.SA for LC in sixty patients with COPD observed less postoperative paCO 2, pain scores and need of rescue analgesics with less hospital stay in SA group stating that SA is more safe technique for LC. [25] Incidence of nausea/vomiting, shoulder pain, VAS was less in CSEA as compared with GA in our study thus shows the merits of CSEA over GA in various parameters including hemodynamic stability and pain reduction however it is limited by the smaller sample size and inclusion of only ASA I/ II cases and these factors could be considered in further research on the topic.…”