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Regional vs general anesthesia in abdominal surgery

Abdominal surgery can be safely performed using regional anesthesia alone in selected high-risk patients, reports the American Journal of Surgery, making this option an attractive alternative to general anesthesia for those with severe pulmonary impairment.

News image

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It is known that smokers and patients with chronic obstructive pulmonary disease (COPD) experience a higher rate of pulmonary-related complications following abdominal surgery.

The impact of anesthetic technique (regional [RA] versus general [GA] versus combination of both) on the complication rate has not been established.

Dr Savas and colleagues from America examined the outcomes of abdominal surgery performed using RA (epidural or continuous spinal) as the sole anesthetic technique in patients with severe pulmonary impairment (SPI).

The researchers reviewed a series of 8 general surgery cases performed using RA alone (T4–T6 sensory level) in patients with SPI, as evidenced by an forced expiratory volume in 1 second (FEV1) less than 50% predicted and/or home oxygen requirement.

1 patient also received postoperative epidural analgesia.

The researchers found that FEV1 ranged from 0.3 to 1.84 L; 3 patients required home oxygen therapy, and 5 of the 8 were American Society of Anesthesiology (ASA) class 4.

Length of stay was less than 24 hours for 5 of 8 patients and mortality was 0%
American Journal of Surgery

The operations reviewed by the research team included segmental colectomy (n = 2), open cholecystectomy (n = 1), incisional herniorrhaphy (n = 1), and laparoscopic herniorrhaphy (n = 4).

The researchers noted that intraoperative conditions were adequate with RA alone for successful completion of the procedure in all cases.

All patients recovered uneventfully except for 1 who developed postoperative pneumonia that resolved with standard therapy.

The researchers recorded that the length of stay was less than 24 hours for 5 of 8 patients and mortality was 0%.

Dr Savas concluded, "Abdominal surgery can be safely performed using RA alone in selected high-risk patients, making this option an attractive alternative to GA for those with severe pulmonary impairment."

American Journal of Surgery; 2004: Volume 188, Issue 5, Pages 603-605
22 November 2004

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