背景:腹腔镜胆囊切除术(LC)是腹部手术中最广泛使用的外科手术之一。患者在全身麻醉期间接受LC;然而,近年来,多项研究表明,清醒患者能够进行LC.我们报告一例清醒LC并进行文献复习。
方法:一名69岁患有严重肺部疾病的胆石症患者计划在区域麻醉下进行LC。我们首先在T8-T9水平进行硬膜外麻醉,然后在T12-L1水平进行脊髓麻醉。患者和外科医生都完全舒适地管理了该程序。腹内压为8mmHg。患者在整个手术过程中保持稳定,术后过程顺利。
结论:有证据证明脊髓和硬膜外麻醉的使用是安全的,具有最小的副作用,易于使用药物管理。选定患者的区域麻醉可能比全身麻醉有一些优势,比如没有气道操纵,维持自主呼吸,有效的术后镇痛,减少恶心和呕吐,和早期恢复。然而,该技术在欧洲没有广泛使用;这是文献中在意大利报道的第一例。区域麻醉在进行某些类型的腹腔镜手术中是可行且安全的。应进行进一步的研究,以在常规临床实践中引入这种类型的麻醉。
BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most widely practiced surgical procedures in abdominal surgery. Patients undergo LC during general anaesthesia; however, in recent years, several studies have suggested the ability to perform LC in patients who are awake. We report a
case of awake LC and a literature review.
METHODS: A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional anaesthesia. We first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 level. The procedure was managed in total comfort for both the patient and the surgeon. The intra-abdominal pressure was 8 mmHg. The patient remained stable throughout the procedure, and the postoperative course was uneventful.
CONCLUSIONS: Evidence has warranted the safe use of spinal and epidural anaesthesia, with minimal side effects easily managed with medications. Regional anaesthesia in selected patients may provide some advantages over general anaesthesia, such as no airway manipulation, maintenance of spontaneous breathing, effective postoperative analgesia, less nausea and vomiting, and early recovery. However, this technique for LC is not widely used in Europe; this is the first
case reported in Italy in the literature. Regional anaesthesia is feasible and safe in performing some types of laparoscopic procedures. Further studies should be carried out to introduce this type of anaesthesia in routine clinical practice.