Interesting question. I'm unaware that this has been tried, but would have to do research first. Why do you think your patient could not have general anesthesia? There should be a very good reason, since spinal anesthesia would not necessarily mean lower cardiovascular risk. Expect major pulmonary problems, i. e. dyspnea, considering a high spinal level would be necessary. My personal opinion: I wouldn't go for it.
We do not know the condition of your patient?
Considering the patient's favored condition, a laparoscopy is possible, but under certain conditions:
- A pneumoperitoneum with the lowest possible pressure.
- spinal anaesthesia with a spinal epidural-combined: make a spinal anaesthesia with 15mg of bupivacaine to have an adequate upper sensory level, and make the maintenancy with the peridural
- Give a moderate sedation to reduce the discomfort.
You may please go through one of our related articles please: https://www.researchgate.net/publication/329889362_Arterial_and_end-tidal_Carbon_Dioxide_Tension_Changes_during_Spinal_Anaesthesia_in_Upper_Abdominal_Laparoscopic_Surgeries_A_Comparison_with_General_Anaesthesia
Well, I don't think spinal will be enough for such procedure. The areas for the laparoscopic ports may be ready but copping with insufflation with attendant sequelae may be detrimental. Diagnostic laparoscopy surgeries are done under sedation now, so in the hand of an expert in laparascopy surgery, spinal anaesthesia plus sedation may be tried. I honestly believe that with adequate counselling the patient will agree to G.A
Dear Dr. Imran,
Lap.chole under SAB is a well explored entity with numerous case studies, case reports and observational studies, majority suggesting its practicality. Sedation has been tried with SAB in some instances. Recognised hindrances to comfort of both surgeons and patients include prolonged operative times with waning sensory levels in complicated cases, shoulder tip pain during capnoperitoneum, symptoms following increased intracerebral pressure to mention a few. Still, considerable advantages in terms of reduced surgical bleeding, superior analgesia and reduced DVT and postoperative pulmonary complications have been identified. Thus, it is a feasible option which is already in use.( You have experience with its use I believe).
Thank you.
Not ready is sometimes a subjective issue, mostly a psychological. A good counselling is most the time very assuring. Otherwise combined spinal epidural is a good alternative, if general anaesthesia is contraindicated.
