[Subarachnoid anesthesia in the repair of urinary stress incontinence using a Burch-type colposuspension by means of extraperitoneal laparoscopy].
Extraperitoneal laparoscopy does not lead to increased intra-abdominal pressure, meaning that the mainly respiratory physiological changes that develop derive from CO2 absorption from the extraperitoneal cavity that is created. Therefore, subarachnoid anesthesia might possibly be appropriate for this type of procedure.


OBJECTIVE
To assess the efficacy of subarachnoid anesthesia for correcting urinary incontinence by extraperitoneal Burch laparoscopic colposuspension.


METHODS
Six consecutive patients undergoing extraperitoneal Burch laparoscopic colposuspension under intradural anesthesia. A lateral decubitus puncture was made and 12 mg of 0.5% hyperbaric bupivacaine was infused with 20 micrograms of fentanyl. We monitored hemodynamic variables, end-tidal CO2 and respiratory frequency. Complications occurring during surgery and recovery were recorded.


RESULTS
Four patients presented intraperitoneal CO2 leaks upon insufflation of the extraperitoneal cavity, with dyspnea and chest-shoulder pain in addition to anxiety and agitation, such that general anesthesia had to be provided. Subcutaneous emphysema was observed to the cervical zone after surgery but discharge was not delayed. The study was halted in view of the results obtained.


CONCLUSIONS
Subarachnoid anesthesia was not effective for extraperitoneal Burch laparoscopic colposuspension because of the impossibility of alleviating discomfort from intraperitoneal leakage and subcutaneous emphysema that can develop during the procedure.
de Santos
P
P
Servicio de Anestesiología, Reanimación y Tratamiento del dolor, Universidad de Barcelona, C/Villarroel no. 170, 08036 Barcelona. psantos@clinic.ub.es
Plaza
A
A
Faulí
A
A
Pérez
J
J
Martínez
S
S
Vanrell
J
J
Gomar
C
C
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D002045:Bupivacaine / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000009:adverse effects; D002637:Chest Pain / Q000209:etiology* / Q000517:prevention & control; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007327:Insufflation / Q000009:adverse effects; D007431:Intraoperative Complications / Q000209:etiology*; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011229:Preanesthetic Medication; D011312:Pressure; D020047:Rectocele / Q000601:surgery; D020069:Shoulder Pain / Q000209:etiology; D013346:Subarachnoid Space; D013352:Subcutaneous Emphysema / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000601:surgery*
D002245:Carbon Dioxide; D005283:Fentanyl; D002045:Bupivacaine