scholarly journals Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia

2021 ◽  
Vol 2 (3) ◽  
pp. 147-153
Author(s):  
Aidyl Fitrisyah ◽  
Rizal Zainal ◽  
Edi Darwis
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Spinal Anesthesia ◽  
Urine Output ◽  
Deep Sedation ◽  
Sensory Block ◽  
Surgical Instruments ◽  
Anesthetic Agent ◽  
Safe Procedure ◽  
Thoracic Spinal

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy. Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesiatechnique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted. Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia

2021 ◽  
Vol 2 (1) ◽  
pp. 158-164
Author(s):  
Aidyl Fitrisyah ◽  
Rizal Zainal ◽  
Darwis Edi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Spinal Anesthesia ◽  
Urine Output ◽  
Deep Sedation ◽  
Sensory Block ◽  
Surgical Instruments ◽  
Anesthetic Agent ◽  
Thoracic Spinal ◽  
Anesthesia Technique

Introduction: Cholelithiasis or gallstones are hardened deposits of digestive fluid that can form in gallbladder. The treatment of gallstones depends upon the stage of disease. Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy). Laparoscopic cholecystectomy removes the gallbladder and gallstones through several small incisions in the abdomen. This case report aims to discuss the managent of segmental thoracic spinal anesthesia in laparoscopic cholecystectomy. Case: We report on the cases of 2 patients who undego elective laparoscopic cholecystectomy. Female, 53 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 1,2 mcg target control infusion (TCI) propofol intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 100 cc, hemodynamically stable. Female, 42 years old, will undergo laparoscopic cholecystectomy, performed anesthesia with segmental thoracic spinal anesthesia technique using the anesthetic agent 3 ml of Levobupivacaine 0,5% + 25 mcg of Fentanyl, requiring a sensory block to at least T10-T11 dermatom. Patients received a 3 mg of midazolam intravenous is administered as intermittent boluses to achieve deep sedation. The operation lasts 1 hour, with a bleeding 15 cc and urine output 150 cc, hemodynamically stable. The level and duration of sensory block, intensity and duration of motor block were recorded. A 20 % or more decrease in MAP compared to baseline was considered as hypotension, iv ephedrine 5 mgr bolus administreted. Conclusion: Laparoscopy is a surgical procedure that uses minimally invasive surgical techniques (minimally invasive surgery) where the doctor uses a small telescope / camera that is inserted into the stomach and surgical instruments in mini form. This procedure has many advantages because it is not invasive, the amount of bleeding can be reduced, postoperative pain can be minimized. Regional anesthesia procedure in laparoscopic cholecystectomy based on several studies and case reports can be performed and is a safe procedure.

scholarly journals Thoracic spinal anesthesia for cesarean section in severe pre-eclampsia: exploring a new dimension

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Rajeev Chauhan ◽  
Pranshuta Sabharwal ◽  
Rashi Sarna ◽  
Shyamcharan Meena
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Anesthetic Management ◽  
Sensory Block ◽  
Lumbar Region ◽  
Lower Segment ◽  
Hemodynamic Stability ◽  
Emergency Situations ◽  
Lower Segment Cesarean Section ◽  
Thoracic Spinal

Abstract Background Severe pre-eclampsia poses a dilemma for the anesthesiologist especially in emergency situations where cesarean deliveries are done for the un-investigated or partially investigated parturient. Hemodynamic stability is the major goal of anesthetic management of these patients. Thoracic spinal anesthesia has been successfully given for various surgeries like breast cancer and abdominal cancer but not for cesarean section. Case presentation We report a case of a 35-year-old at 33+5-week period of gestation with severe pre-eclampsia and bullous lesions managed successfully with segmental thoracic spinal anesthesia. General anesthesia in this patient could have been risky as the patient was not fasting; airway bullous lesions could not be ruled out and Mallampati grade was III on airway examination. Presence of lesions in lumbar region precluded the lumbar spinal technique. The technique was associated with an adequate level of the sensory block during lower segment cesarean section, a high degree of hemodynamic stability, and a high patient satisfaction Conclusion Segmental thoracic spinal anesthesia can be used successfully and effectively for lower segment cesarean section by experienced anesthetists. Further studies are warranted to compare its effect, especially on hemodynamics with known techniques.

Acute reduction of cerebrospinal fluid volume prior to spinal anesthesia: implications for sensory block extent

2020 ◽  
Vol 86 (6) ◽  
Author(s):  
Martin F. Bjurström ◽  
Niklas Mattsson ◽  
Andreas Harsten ◽  
Nicholas Dietz ◽  
Mikael Bodelsson
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Fluid Volume ◽  
Cerebrospinal Fluid Volume

scholarly journals Video-assisted minimal access surgery for complicated mitral valve endocarditis, tricuspid valve insufficiency and progressive coronary disease after previous CABG - in the time of COVID-19: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Terézia B. Andrási ◽  
Nunijiati Abudureheman ◽  
Alannah Glück ◽  
Maximilian Vondran ◽  
Gerhard Dinges ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Surgical Instruments ◽  
Tricuspid Valve Repair ◽  
Long Term Outcome ◽  
Tricuspid Valve Insufficiency ◽  
Valve Insufficiency ◽  
Neurosurgical Intervention

Abstract Background The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. Case presentation A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery. Conclusion The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.

Kinematics of a Fully-Decoupled Remote Center-of-Motion Parallel Manipulator for Minimally Invasive Surgery

2012 ◽  
Vol 6 (2) ◽  
Author(s):  
Chin-Hsing Kuo ◽  
Jian S. Dai
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Inverse Kinematics ◽  
Parallel Manipulator ◽  
Degrees Of Freedom ◽  
Surgical Instruments ◽  
End Effector ◽  
Minimally Invasive Surgical ◽  
Inverse Kinematics Problem

A crucial design challenge in minimally invasive surgical (MIS) robots is the provision of a fully decoupled four degrees-of-freedom (4-DOF) remote center-of-motion (RCM) for surgical instruments. In this paper, we present a new parallel manipulator that can generate a 4-DOF RCM over its end-effector and these four DOFs are fully decoupled, i.e., each of them can be independently controlled by one corresponding actuated joint. First, we revisit the remote center-of-motion for MIS robots and introduce a projective displacement representation for coping with this special kinematics. Next, we present the proposed new parallel manipulator structure and study its geometry and motion decouplebility. Accordingly, we solve the inverse kinematics problem by taking the advantage of motion decouplebility. Then, via the screw system approach, we carry out the Jacobian analysis for the manipulator, by which the singular configurations are identified. Finally, we analyze the reachable and collision-free workspaces of the proposed manipulator and conclude the feasibility of this manipulator for the application in minimally invasive surgery.

EVALUATION OF CLINICO-RADIOLOGICAL FACTORS PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 63-66
Author(s):  
Wasif Mohammad Ali ◽  
Nazia Nanen ◽  
Atia Zaka Ur Rab ◽  
Syed Amjad Ali Rizvi ◽  
Mehtab Ahmad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Previous History ◽  
Safe Procedure ◽  
Chi Square ◽  
Preoperative Prediction ◽  
Conversion To Open Cholecystectomy ◽  
Chi Square Test ◽  
A Prospective Study

Introduction: Laparoscopic cholecystectomy has become procedure of choice for treatment of symptomatic gallstone [1] disease . Even though it is a safe procedure occasionally it can be difcult and requires conversion to open cholecystectomy for various problems faced during surgery. Preoperative prediction of difcult laparoscopic cholecystectomy and likelihood of conversion to open cholecystectomy will avoid such complications and overall cost of treatment. Aim: To evaluate the clinico-radiological factors predicting difcult laparoscopic cholecystectomy Methods: This was a prospective study conducted from October 2018 to November 2020. Total of 101 patients meeting inclusion criteria undergoing laparoscopic cholecystectomy were included in the study. Various clinical, radiological and biochemical parameters and intraoperative difculties during surgery were recorded. The statistical analysis was done using chi-square test and ANOVA test. Results: The parameters such as sex, age, duration of disease, co-morbid disease, previous history of cholecystitis, palpable gall bladder, BMI, TLC, thickness of gall bladder, largest stone size and impacted stone are found statistically signicant in predicting difcult laparoscopic cholecystectomy and conversion to open cholecystectomy preoperatively. Conclusion: Difcult laparoscopic cholecystectomy may be predicted preoperatively even with a good clinical judgement whereas both clinical and radiological parameters provide a better preoperative prediction of difcult cholecystectomy so that the surgeon can prepared in advance for the complications.

scholarly journals Spinal Versus General Anesthesia for Laparoscopic Cholecystectomy

2018 ◽  
Vol 25 ◽  
pp. 55-58
Author(s):  
SMA Taher ◽  
Jamil Raihan ◽  
M Abu Zahid ◽  
AK Azad ◽  
MI Alam ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Regional Anesthesia ◽  
Gold Standard ◽  
Randomised Trial ◽  
Gall Stone ◽  
Chronic Obstructive ◽  
First Time ◽  
Symptomatic Gall Stone

Laparascopic Cholecystectomy under regional anesthesia alone has been reported only with severe chronic obstructive airway disease1,2. In a randomised trial, epidural with general anesthesia have been found to be more effective in lessening postoperative pain compare with general anesthesia alone3. Regional anesthesia has been successfully used for laparascopic cholecystectomy in patient. Hamad and Ibrahim El-Khatter4 used spinal anesthesia for laparoscopic for the first time. We performing Laparascopic Cholecystectomy with carbondioxide pneumoperitoneum under spinal anesthesia alone of healthy patients with symptomatic gall stone disease5. We design a control randomized trial to compare spinal anesthesthesia with the Gold standard general anesthesia for elective Laparascopic Cholecystectomy in healty patients.TAJ 2012; 25: 55-58

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