Continuous Spinal Anaesthesia (CSA) for Emergency Laparotomy in High-Risk Elderly patients: Technique and Outcomes of a Prospective Service Evaluation

Niraj, G.; Basar, Siti H.M.A; Warusawitharana, Chinthaka; Sebastian, Siby; Camacho, E; Internationals, Ommega

doi:10.15436/2377-1364.17.097

Cited by 4 publications

(1 citation statement)

References 12 publications

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“…On a similar note, the selection of patients for this approach still remains individualised given the wide range of indications for laparotomy; there is significant variability in the surgical interventions and individual patient characteristics leading to the choice of approach. Given the lack of evidence highlighted by the literature review, the non-peer-reviewed works of Basar et al [ 9 ] and Farda et al [ 10 ] are of potential interest despite their limitations, as they describe other approaches to regional anaesthesia in the setting of laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Locoregional Anaesthesia for Laparotomy: A Literature Review and Subsequent Case Series Highlighting the Potential of an Alternative Anaesthetic Technique

Coe,

Shuttleworth,

Rangappa

et al. 2023

Cureus

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Laparotomy is a surgical incision utilised in both emergency and elective scenarios to gain access to abdominal surgery. General anaesthesia is usually necessitated due to the substantial insult of the approach and to facilitate organ relaxation and paralysis. However, this brings with it the need for an assessment of the suitability of the anaesthetic technique, with a large number of patients having comorbidities significant enough to exclude them from surgery. Locoregional anaesthesia, provided via spinal, epidural, or a combined approach offers a means of providing anaesthesia that places a reduced level of strain on patients’ cardiorespiratory function. We review the existing literature on the topic of so-called "awake laparotomy" performed with locoregional anaesthesia and present a case series including both elective and emergency procedures.

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Section: Discussionmentioning

confidence: 99%

Locoregional Anaesthesia for Laparotomy: A Literature Review and Subsequent Case Series Highlighting the Potential of an Alternative Anaesthetic Technique

Coe,

Shuttleworth,

Rangappa

et al. 2023

Cureus

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Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review

Leoni,

Rossi,

Mercieri

et al. 2024

JPM

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Emergency laparotomy is a surgical procedure associated with significantly higher mortality rates compared to elective surgeries. Awake laparotomy under neuraxial anaesthesia has recently emerged as a promising approach in abdominal surgery to improve patient outcomes. This study aims to evaluate the feasibility and potential benefits of using neuraxial anaesthesia as the primary anaesthetic technique in emergency laparotomies. We conducted a case series involving 16 patients who underwent emergency laparotomy for bowel ischemia, perforation, or occlusion. Neuraxial anaesthesia was employed as the main anaesthetic technique. We analysed patient demographics, clinical characteristics, intraoperative details, and postoperative outcomes. The primary outcome measures included the adequacy of postoperative pain control, the incidence of postoperative complications, and mortality rates. Among the 16 patients, adequate postoperative pain control was achieved, with only 2 patients requiring additional analgesia. Postoperative complications, including sepsis, wound dehiscence, and pneumonia, were observed in seven patients (44%). The observed mortality rate was relatively low at 6% (one patient). Notably, conversion to general anaesthesia was not necessary in any of the cases, and no early readmissions were reported. Our findings highlight the feasibility and potential benefits of using neuraxial anaesthesia in emergency laparotomies. The observed low mortality rate and the avoidance of conversion to general anaesthesia suggest that neuraxial anaesthesia may be a useful alternative in emergency settings. However, the occurrence of postoperative complications in 44% of patients indicates the need for cautious patient selection and close monitoring. Further research with larger sample sizes is warranted to fully elucidate the efficacy, safety, and potential impact of this technique on patient outcomes in emergency laparotomies.

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Awake robotic liver surgery: A case report

Delvecchio,

Pavone,

Conticchio

et al. 2023

World J Gastrointest Surg

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BACKGROUND In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease. CASE SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal–epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful. CONCLUSION Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.

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Continuous Spinal Anaesthesia (CSA) for Emergency Laparotomy in High-Risk Elderly patients: Technique and Outcomes of a Prospective Service Evaluation

Cited by 4 publications

References 12 publications

Locoregional Anaesthesia for Laparotomy: A Literature Review and Subsequent Case Series Highlighting the Potential of an Alternative Anaesthetic Technique

Locoregional Anaesthesia for Laparotomy: A Literature Review and Subsequent Case Series Highlighting the Potential of an Alternative Anaesthetic Technique

Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review

Awake robotic liver surgery: A case report

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