Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study.
BACKGROUND
Spinal anesthesia has been successfully used to perform various laparoscopic procedures. However, laparoscopic cholecystectomy under spinal anesthesia has not been reported. Is this feasible?


METHODS
Ten successive laparoscopic cholecystectomies were performed under spinal anesthesia. The surgical technique was modified using nitrous oxide insufflation, lower levels of intraabdominal pressure, modified trocar sites, and minimal surgical manipulation. We used spinal anesthesia by intrathecal hyperbaric 10-12 mg bupivacaine with 10 microg fentanyl to give an anesthetic level at T8-T6.


RESULTS
The mean age was 39.3 years and there were four females. Only one patient was converted to general anesthesia due to intolerable shoulder pain. One patient vomited intraoperatively. Nine patients considered the procedure well tolerated under spinal anesthesia. The mean operative time was 47.4 min. Postoperatively, there were minimal pain and no vomiting.


CONCLUSIONS
Laparoscopic cholecystectomy can be performed successfully under spinal anesthesia and is well tolerated.
Hamad
M A
MA
Department of General Surgery, Assiut University Hospital, 71516 Assiut, Egypt. mostafa_hamad@yahoo.com
El-Khattary
O A Ibrahim
OA
D000328:Adult; D000775:Anesthesia, Spinal; D002045:Bupivacaine; D017081:Cholecystectomy, Laparoscopic; D005240:Feasibility Studies; D005260:Female; D005283:Fentanyl; D006801:Humans; D007327:Insufflation; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000209:etiology; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011312:Pressure; D011446:Prospective Studies; D020069:Shoulder Pain / Q000209:etiology; D014839:Vomiting / Q000209:etiology
D009609:Nitrous Oxide; D005283:Fentanyl; D002045:Bupivacaine