|Discussion in 'All Categories' started by Howard Kenig - Jan 17th, 2012 6:35 pm.|
|Hx of adverse reaction to inhalant anesthesia and slow liver metabolism, as well as laryngeal spasm. Is there a viable anesthesia alternative for cholecystectomy?
re: gall bladder disease and surgery by Dr M.K. Gupta - Jan 22nd, 2012 3:06 am
Dr M.K. Gupta
Non-invasive therapy aims to minimize the trauma associated with a interventional process but nonetheless achieve a satisfactory therapeutic result.
The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This idea has been extended to include laparoscopic cholecystectomy and hernia repair. Reports happen to be published confirming the safety of 24 hour discharge for the majority of patients. However, we'd caution against overenthusiastic ambulatory laparoscopic cholecystectomy around the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications.
Intraoperative complications of laparoscopic surgery are mostly because of traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation.
General anesthesia and controlled ventilation comprise the accepted anesthetic method to reduce the rise in PaCO2. Investigators recently documented the cardiorespiratory compromise related to upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is suggested in these patients.
Anesthesiologists must conserve a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative vomiting and nausea are among the most typical and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be a highly effective oral and IV prophylaxis against postoperative emesis in preliminary studies.
Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery.
There is no conclusive evidence to demonstrate clinically significant results of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has shown to be a significant advance in the treatment of patients with symptomatic gallbladder disease.
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