Summary:
Nowadays, laparoscopic surgeries are being performed
under subarachnoid block (SAB) safely.
Aims: This study was to compare the arterial and end-tidal
carbon dioxide (CO2) tension changes during spinal and
general anaesthesia (GA) in CO2 pneumoperitoneum for
upper abdominal laparoscopic surgeries.
Settings and Design: This was a prospective randomized
comparative clinical study.
Materials and Methods: Eighty patients posted for upper
abdominal laparoscopic surgeries were randomly allocated
to two groups either to receive standard GA or lumbar SAB.
Results: The demographic profiles of both the groups were
comparable. The PaCO2 was increased gradually and
sustained at its peaks within 20±4.37 minutes in both the
groups. The mean±SD revealed to be higher in Group B
(41.5500±2.1315) than Group A (40.8460±2.1136), but the
difference between the two was not statistically significant
(P=0.6142). There was a gradual increase in ETCO2 over
the initial 10±2.07 minutes and reached a plateau within
20±5.74 minutes in both the groups and declined faster
after deflation of pneumoperitoneum in SAB group. The
mean±SD was found to be higher in Group B
(33.923±1.642) than Group A (33.408±1.772), but it was
also not statistically significant (P=0.4492). The difference
of the arterial blood pH between the groups was not
statistically significant. Three (7.5%) patients developed
transient urinary retention and 2 (5%) patients suffered
from post-dural puncture headache in SAB group.
Conclusions: Arterial and end-tidal CO2 tension changes
during upper abdominal laparoscopic surgery under SAB
remain within physiological limit and comparable to the
CO2 tensions under GA. However, per-operative
complications in SAB are greater, while it is lesser in
postoperative period in comparison to GA. SAB may be
adopted in ASA physical status I patients with proper
preoperative counselling.
Key-words: Upper abdominal surgery, Laparoscopic
surgery, Subarachnoid block, General anaesthesia, CO2
tension changes.
(J Bangladesh Coll Phys Surg 2019; 37: 13-18)