COMBINED EXTENSIVE EPIDURAL/ GENERAL ANESTHESIA USING PROSEAL LARYNGEAL MASK AIRWAY FOR MAJOR ABDOMINAL LAPAROSCOPIC SURGERY
Author: Tuan Anh Nguyen M.D, Department of Anesthesiology and Pain Medecine, University Medical Center, Hochiminh City, Vietnam
email: [email protected], Tel: +84 (0) 903185906
Introduction: Combined Epidural/General Anesthesia (CEGA) using ETT is preferable for major abdominal laparoscopic surgery. Recently GA using ProSeal LMA (PLMA) is replaceable to ETT. Our aims were to estimate the feasibility of Combined Extensive Epidural Gereral Anesthesia using PLMA (CEEGA/PLMA) for major abdominal laparoscopic surgery in our hospital.
Materials and methods: CEEGA initiated by EA performed at T10-11 or L2-3 depends on site of surgery. Bolus dose (10 ml Bupivacaine 0.5% + 10 ml Lidocaine 2%) was given via epidural catheter. After sensory lost archived at dermatome of T4, anesthesia induction by I.V Propofol (2-3mg/kg) + I.V Fentanyl (2mcg/kg), PLMA inserted without muscle relaxant. Servorane, continuous EA (5-15 ml/h of Bupivacaine 0.25% added 2 mcg/ml of Fentanyl), EtCO2 ≤ 45 mmHg were maintained peroperatively. Small I.V dose bolus of Rocuronium 5-10 mg ± Fentanyl 50 mcg adjusted if necessary. Hypotension (decrease of SBP ≥ 20% compared to base line) treated by accelerating of I.V Crystalloid perfusion ± interval bolus of I.V Ephedrine (3-5mg). Postop EA (Bupivacaine 0.1% + Fentanyl 2 mcg/ml) kept within 24 to 72 hours. Adequate surgical condition without addition of Rocuronium ± Fentanyl was the primary end point. Perioperative pain and first flatus were also noted.
Results: Thirty six patients (ASA I - III, aged 21 - 81, weighted 51 ± 10 kg, surgery time 168 ± 55 min) underwent major laparoscopic surgery (34 colorectal resection; 1 gastrectomy; 1 liver resection) were performed under CEEGA/PLMA. Thirty three patients were successfully operated with adequate surgical condition without Rocuronium ± Fentanyl. Only two patients needed small doses of Rocuronium (10-20 mg) ± Fentanyl (50-100 mcg). Surgery was postponed in one colorectal patient due to total spinal anesthesia complication. Hypotension required Ephedrine was in 17 (48.6%) and twenty 26 (74.3%) patients at induction & peroperative period, respectively. Extubation at 6.4 ± 5.9 min after completion of surgery. Pain Score (VAS) ≤ 3 in 33/35 patients (94.3%) within 24h postop, first flatus in 31/35 (87.1%) patients was 20.7 ± 10.3 h.
Discussion: CEEGA/PLMA was feasible for 35 cases of major abdominal laparoscopic surgery. Sugical condition was sufficient in 33/35 cases (94.3%). Extubation was fast & smoothy in recovery period. Exellent pain relief, early flatus returned within 24h were important benefits. However, attention must be paid to hypotension.