Key result
Combined spinal-epidural anesthesia enables successful laparotomy without general anesthesia in high-risk elderly patients.
Why the study?
Many patients undergoing laparotomy have comorbidities that exclude them from general anaesthesia, necessitating alternative anaesthetic techniques.
Does locoregional anaesthesia provide a viable alternative to general anaesthesia for patients undergoing laparotomy?
Case Series (n=3)
No
Does locoregional anaesthesia provide a viable alternative to general anaesthesia for patients undergoing laparotomy?
Locoregional anaesthesia may offer a viable alternative for laparotomy in patients with significant comorbidities that preclude general anaesthesia.
Answers are grounded in this paper and cite their sources.
May enable laparotomy in high-comorbidity patients unsuitable for general anesthesia; leaves open need for prospective validation.
Laparotomy is a surgical incision utilised in both emergency and elective scenarios to gain access to abdominal surgery. General anaesthesia is usually necessitated due to the substantial insult of the approach and to facilitate organ relaxation and paralysis. However, this brings with it the need for an assessment of the suitability of the anaesthetic technique, with a large number of patients having comorbidities significant enough to exclude them from surgery. Locoregional anaesthesia, provided via spinal, epidural, or a combined approach offers a means of providing anaesthesia that places a reduced level of strain on patients' cardiorespiratory function. We review the existing literature on the topic of so-called "awake laparotomy" performed with locoregional anaesthesia and present a case series including both elective and emergency procedures.
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Coe et al. (2023) conducted a case series in High risk for general anaesthesia requiring laparotomy (n=3). Combined spinal and epidural anaesthesia was evaluated on Successful completion of surgery without conversion to general anaesthesia. Combined spinal and epidural anaesthesia enabled successful laparotomy without conversion to general anaesthesia in three elderly patients deemed high risk for general anaesthesia.
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