Comparison of the Effects of Thoracic Epidural Anesthesia with General Anesthesia on Hemodynamic Changes and its Complications in Patients Undergoing Laparoscopic Cholecystectomy

Majedi, Mohammad Azad; Sarlak, Shahab; Sadeghi, Yasaman; Ahsan, Behzad

Comparison of the Effects of Thoracic Epidural Anesthesia with General Anesthesia on Hemodynamic Changes and its Complications in Patients Undergoing Laparoscopic Cholecystectomy

Document Type : Original Article

Authors

¹ Department of Anesthesiology, Kurdistan University of Medical Sciences, Sanandaj, Iran

² Department of Medicine, General Physician, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Epidural anesthesia (EA) today has been used extensively in surgical procedures and the management of pain associated with midwifery and chronic pain. This type of anesthesia can be done in different technical, physiological, and pharmacological ways. The aim of this study was to compare the effects of thoracic EA with general anesthesia (GA) on hemodynamic changes and its complications in patients underwent laparoscopic colonoscopy. Materials and Methods: This clinical trial study was conducted on 80 patients undergoing laparoscopic cholecystectomy with EA or GA based on inclusion and exclusion criteria. The patients were randomly divided into two groups of 40 and changes in blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and arterial blood oxygen saturation were measured. The incidence of nausea, vomiting, chills, and itching in the two groups was recorded. The analysis was performed descriptively and also using t-test and Chi-square tests. Results: The results showed that the mean of SBP and DBP, HR, and arterial blood oxygen saturation and the incidence of nausea and vomiting was statistically significant (P < 0.05) between the two groups at 4, 6, and 12 h after anesthesia and it was higher in a group of GA. There was no significant difference in shivering and itching between the two groups (P > 0.05). Conclusion: The results of this study indicated that thoracic EA in patients with laparoscopic cholecystectomy has significant effects on factors such as SBP and DBP and arterial blood oxygen saturation. Furthermore, EA has fewer complications than GA, and it is the preferable approach

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References

1.	Joris J, Cigarini I, Legrand M, Jacquet N, De Groote D, Franchimont P, et al. Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy. Br J Anaesth 1992;69:341-5.
2.	Odeberg-Wernerman S. Laparoscopic surgery – Effects on circulatory and respiratory physiology: An overview. Eur J Surg Suppl. 2000; 585:4-11.
3.	Yegin A, Erdogan A, Kayacan N, Karsli B. Early postoperative pain management after thoracic surgery; pre- and postoperative versus postoperative epidural analgesia: A randomised study. Eur J Cardiothorac Surg 2003;24:420-4.
4.	Lee JH, Huh J, Kim DK, Gil JR, Min SW, Han SS, et al. Laparoscopic cholecystectomy under epidural anesthesia: A clinical feasibility study. Korean J Anesthesiol 2010;59:383-8.
5.	Wahba RW, Mamazza J. Ventilatory requirements during laparoscopic cholecystectomy. Can J Anaesth 1993;40:206-10.
6.	Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, et al. The incidence of awareness during anesthesia: A multicenter United States study. Anesth Analg 2004;99:833-9.
7.	Jenkins K, Baker AB. Consent and anaesthetic risk. Anaesthesia 2003;58:962-84.
8.	American Society of Anesthesiologists. Continuum of Depth of Sedation Definition of General Anesthesia and Levels of Sedation/Analgesia. Amended 21 October, 2009. American Society of Anesthesiologists; 27 October, 2004. Available from: http://www.asahq.org/publicationsAndServices/standards/20.pdf. [Last accessed on 2009 Dec 01].
9.	Fujii Y, Toyooka H, Tanaka H. Efficacy of thoracic epidural analgesia following laparoscopic cholecystectomy. Eur J Anaesthesiol 1998;15:342-4.
10.	Safaeian R, Movasaghi GH. Comparison between incidence of postoperative nausea and vomiting after total abdominal hysterectomy in general and epidural anesthesia. Razi J Med Sci 2001;8:308-11.
11.	Senoglu N, Yuzbasioglu MF, Oksuz H, Yildiz H, Dogan Z, Bulbuloglu E, et al. Effects of epidural-and-general anesthesia combined versus general anesthesia alone on femoral venous flow during laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2010;20:219-23.
12.	Savas JF, Litwack R, Davis K, Miller TA. Regional anesthesia as an alternative to general anesthesia for abdominal surgery in patients with severe pulmonary impairment. Am J Surg 2004;188:603-5.
13.	Cheng YC, Cheng XB, Li XJ, Wang FZ, Li ZK. Combined general and regional anesthesia and effects on immune function in patients with benign ovarian tumors treated by laparoscopic therapy. Int J Clin Exp Med 2013;6:716-9.
14.	Huppelschoten AG, Bijleveld K, Braams L, Schoot BC, van Vliet HA. Laparoscopic sterilization under local anesthesia with conscious sedation versus general anesthesia: Systematic review of the literature. J Minim Invasive Gynecol 2018;25:393-401.
15.	Atkinson TM, Giraud GD, Togioka BM, Jones DB, Cigarroa JE. Cardiovascular and ventilatory consequences of laparoscopic surgery. Circulation 2017;135:700-10.
16.	Zhu J, Zhang XR, Yang H. Effects of combined epidural and general anesthesia on intraoperative hemodynamic responses, postoperative cellular immunity, and prognosis in patients with gallbladder cancer: A randomized controlled trial. Medicine (Baltimore) 2017;96:e6137.
17.	Gupta A, Gupta K, Gupta PK, Agarwal N, Rastogi B. Efficacy of thoracic epidural anesthesia for laparoscopic cholecystectomy. Anesth Essays Res 2011;5:138-41. [Full text]
18.	Fuji T, Wang CJ, Fujita S, Kawai Y, Nakamura M, Kimura T, et al. Safety and efficacy of edoxaban, an oral factor Xa inhibitor, versus enoxaparin for thromboprophylaxis after total knee arthroplasty: The STARS E-3 trial. Thromb Res 2014;134:1198-204.
19.	Zeng X, Jiang J, Yang L, Ding W. Epidural dexmedetomidine reduces the requirement of propofol during total intravenous anaesthesia and improves analgesia after surgery in patients undergoing open thoracic surgery. Sci Rep 2017;7:3992.
20.	Khajavi MR, Asadian MA, Imani F, Etezadi F, Moharari RS, Amirjamshidi A, et al. General anesthesia versus combined epidural/general anesthesia for elective lumbar spine disc surgery: A randomized clinical trial comparing the impact of the two methods upon the outcome variables. Surg Neurol Int 2013;4:105.
21.	Pei L, Tan G, Wang L, Guo W, Xiao B, Gao X, et al. Comparison of combined general-epidural anesthesia with general anesthesia effects on survival and cancer recurrence: A meta-analysis of retrospective and prospective studies. PLoS One 2014;9:e114667.

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