Document Type : Original Article
Authors
1
Department of Anesthesia and Intensive care unit ,faculty of medicine, Minia University, Egypt
2
Anesthesiology and Intensive care department, Faculty of Medicine, El-Minia University, Egypt.
3
Department of Anesthesia and Intensive Care unit, Faculty of medicine, Minia University, Egypt
4
Department of Anesthesia and intensive care unit, faculty of Medicine, Minia University, Egypt
Abstract
Background and Aim of the work:General anesthesia(GA) is the preferred anesthetic technique for laparoscopic hysterectomy(LH). However, laparoscopic surgery is accompanied with marked stress response, Adding regional techniques,to GA was used to overcome these significant hemodynamic effects .The aim of our study is to compare the effect of combined spinal-general anesthesia with that of combined epidural-general anesthesia on hemodynamic stress ,Requirement of Isoflurane, analgesics and vasodilators,recovery profile ,VAS score at recovery, the time for first analgesic request, surgeon’s satisfaction, and intraoperative and postoperative complications.
Methods:This was a prospective randomized controlled study including 105 female patients,aged 45-65 years old,belonging to ASA I or II grade who underwent LH.They were randomly assigned to one of three equal groups.Group S-GA received spinal combined with general anesthesia; group E-GA received epidural along with GA; and group GA received only general anesthesia. Intraoperatively, cardiovascular parameters and SpO2 were recorded.operative field assessed by surgeons ,isoflurane ,nitroglycrine and opoid consumption were recorded also post operative pain, intra and postoperative complication.
Results: S-GA and E-GA groups showed stable hemodynamic parameters (MAP and HR) at pneumoperitoneum and during surgical manipulation. However, MAP decreased significantly at postinduction in groups S-GA and E-GA.Intraoperatively, consumption of isoflurane, opioid and nitroglycerine infusion was higher in group GA .groups S-GA and E-GA showed better operative field ,pain scores ,fast recovery and longer postoperative analgesia .Incidence of postoperative complications was low.
Conclusion:spinal or epidural anesthesia, combined with general anesthesia was an effective for attenuation of the hemodynamic stress response associated with peumoperitoneum without increasing side effects
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