title: Combined spinal and general anesthesia is better than general anesthesia alone for laparoscopic hysterectomy.
abstract: BACKGROUND
  Spinal anesthesia (SA) was combined with general anesthesia (GA) for achieving hemodynamic stability in laparoscopic hysterectomy.
  
  
  OBJECTIVE
  The aim of our study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability in laparoscopic hysterectomy. The secondary outcomes studied were requirement of inhaled anesthetics, vasodilators, and recovery profile.
  
  
  METHODS
  We conducted a prospective, randomized study in ASAI/II patients posted for laparoscopic hysterectomy, who were willing to participate in the study.
  
  
  METHODS
  Patients were randomly assigned to receive SA with GA (group SGA) or plain GA (group GA). Group SGA received 10 mg bupivacaine (heavy) for SA. GA was administered using conventional balanced technique. Maintenance was carried out with nitrous oxide, oxygen, and isoflurane. Comparison of hemodynamic parameters was carried out during creation of pneumoperitoneum and thereafter. Total isoflurane requirement, need of vasodilators, recovery profile, and regression of SA were studied.
  
  
  METHODS
  Descriptive statistics in the form of mean, standard deviation, frequency, and percentages were calculated for interval and categorical variables, respectively. One-way analysis of variance (ANOVA) was applied for noting significant difference between the two groups, with chi-square tests for categorical variables and post-hoc Bonferroni test for interval variables. Comparison of heart rate (HR), mean arterial pressure (MAP), SPO2, and etCO2 was done with Student's t-test or Mann-Whitney test, wherever applicable.
  
  
  RESULTS
  Patients in group SGA maintained stable and acceptable MAP values throughout pneumoperitoneum. The difference as compared to group GA was statistically significant (P < 0.01). Group GA showed additional requirement of metoprolol (53.33%) and higher concentration of isoflurane (P < 0.001) to combat the increased MAP. Recovery was early and quick in group SGA as against group GA (P = 0.000). There were no adverse/residual effects of SA.
  
  
  CONCLUSIONS
  The hemodynamic repercussions during pneumoperitoneum can be effectively attenuated by combining SA and GA, without any adverse effects.
authors.affiliation: Department of Anaesthesiology, Shrimati Kashibai Navale Medical College, Pune, Maharashtra, India.
authors.forename: Poonam S
authors.initials: PS
authors.lastname: Ghodki
authors.affiliation: Department of Anaesthesiology, Shrimati Kashibai Navale Medical College, Pune, Maharashtra, India.
authors.forename: Shalini P
authors.initials: SP
authors.lastname: Sardesai
authors.affiliation: Department of Anaesthesiology, Shrimati Kashibai Navale Medical College, Pune, Maharashtra, India.
authors.forename: Ramesh W
authors.initials: RW
authors.lastname: Naphade
keywords: General anesthesia; hemodynamics; laparoscopy; pneumoperitoneum; spinal anesthesia