Key result
Spinal anesthesia for emergency laparotomies appears feasible in resource-limited settings with a ~16% complication rate.
Why the study?
The safety and efficacy of using spinal anesthesia as a substitute for general anesthesia in emergency laparotomy had not been explored in Afghanistan.
Is spinal anesthesia safe and effective for emergency laparotomies in a resource-limited setting?
Observational (n=196)
No
Is spinal anesthesia safe and effective for emergency laparotomies in a resource-limited setting?
Spinal anesthesia is a feasible and safe alternative to general anesthesia for emergency laparotomies in resource-limited settings.
May support spinal anesthesia in resource-limited settings; hypothesis-generating and requires randomized confirmation before practice change.
Background Laparotomy is most commonly performed under general anesthesia, but spinal anesthesia (SA) is considered an alternative to in the context of limited resources. The safety and efficacy of using SA as substitute for GA has not been explored in Afghanistan. Methodology We conducted an observational study in the general surgery department of Isteqlal hospital in Kabul, Afghanistan on 196 adult patients undergoing emergency laparotomy under spinal anesthesia between April 2018-April 2020. Results The mean age of patients was 41.5 years (SD=19.4), the ratio of males to females was 1.9:1 and almost half (44.4%) had comorbidities. 21% were classified as ASA grade III and IV with a similar pattern among males and females. 11 (5.6%) cases were converted to GA. Conversion pattern to GA was similar among males and females (P=0.71), ASA grade (P=0.432) and age group (P=0.642). The mean length of stay after operation was 6.5 days (SD=4.1). 32 (16.3%) patients suffered SA complications with no significant difference in according to sex (P=0.134). Hypotension and headache accounted for 97% of complications. Complication rates were similar in terms of intervertebral level (P=0.349), type of abdominal incision (P>0.1) and average length of stay (P=0.156). 18 patients (9.2%) died due to MOF, sepsis, respiratory failure, thromboembolism and cardiogenic shock.Conclusion SA is considered a safe and effective anesthesia for emergency laparotomies, even for those with comorbidities. Based on our findings we would recommend SA as an alternative to GA in emergency laparotomy in Afghanistan.
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Farda et al. (2020) conducted an observational in Emergency laparotomy (n=196). Spinal anesthesia was evaluated on Complications and conversion to general anesthesia. Spinal anesthesia for emergency laparotomies was associated with a 16.3% complication rate and a 5.6% conversion rate to general anesthesia, demonstrating its safety and feasibility in a resource-limited setting.
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