Published Jan 16, 2004
I would like to hear some opinions about anesthesia options for this procedure. I am a nursing student and my father will be having this operation in about 6 months. Info about the surgery or resources with info would be greatly appreciated. thank you
There are no real options once the decision has been made to procede laproscopically. One MUST be intubated and ventilation controlled to control the CO2 increase from the abdominal gas. Also, the abdominal contentsand increased pressure force the diaphragm cephalad and it would be exceedingly hard to breath. ETT with full muscle relaxation will be the anesthetic de-jour.
actually that isn't true... you can do laparoscopic procedures in the pelvis without general anesthesia - in fact many pelvic laparoscopic procedures (tubals, oophorectomies, hernia repairs) can be done with spinals or LMA... it all depends on how good and quick your surgeon is...
however, if the surgeon were to choose to do it without laparsoscopy then it could be done only with local....
Funny, we were taught that laproscopic procedures required an ETT. Well i learn something daily, thanks.
I still remember the old days when all laparoscopic patients had to have a foley. Glad things have progressed. Personally, I don't see much difference in recovery with laparoscopic hernia repair vs. open other than about an additional $1000+ in hospital charges. Usually the incision is quite small to begin with. When I was in the OR all of the time we used to have big discussions about this procedure and decided that it only really helped the surgeon's pocket. None of us would have had it done laparoscopically, local with sedation is the way to go with Marcaine at the end. Just my opinion though.
the only laparoscopic procedures that require an ETT (not that there are any true rules about this - so this is based on my opinion): 1) patient who would be an ETT no matter what (severly ill, prolonged surgery, severe Reflux, etc...) 2) upper abdominal laparoscopy (gallbladder, fundoplication) 3) surgeries that require high intra-abdominal pressures that would compromise ventilation....
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