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SELECTIVE SPINAL VS DESFLURANCE ANESTHESIA IN OUTPATIENT LAPAROSCOPY.

Departments of Anesthesia and Gynecology. Vancouver Hospital and Health Science Center, Room 3200, 910 West 10th Avenue, Vancouver BC. V5Z4E3

INTRODUCTION

Selective spinal anesthesia (SSA) is a technique which allows minimal doses of conventional intrathecal anesthetic agents be used to obtain anesthesia of specific nerve roots and selective modalities. It allows preservation of motor function and maintains the integrity of the dorsal columns while providing pin-prick anesthesia .We undertook a study to compare recovery characteristics of patients using this technique to a desflurane (Des) based technique which is associated with a fast recovery profile in ambulatory patients.

METHODS

In a randomized prospective controlled study, we obtained institutional ethics approval and informed consent from 20 ASA 1-11 patients undergoing gynecologic laparoscopic surgery. SSA patients received lidocaine 10mg and sufentanil 10 g in a hypobaric solution intrathecally. Des patients were induced using fentanyl, propofol and mivacurium, and were maintained with desflurane, nitrous oxide and oxygen using BIS monitoring. Surgical conditions and recovery profiles were recorded for each patient.

RESULTS

The groups had similar demographic characteristics. Surgical conditions were good in all patients. No patients complained of abdominal pain though two had shoulder tip pain that did not require treatment. Time to attain an Aldrete score >9 in the first 2 minutes, times to eye opening, extubation, orientation, straight leg raising and ambulation (p value < 0.0001) were significantly shorter in the SSA group. 50% of patients in the Des group complained of postoperative pain compared to no patient in the SSA group.

The use of a selective spinal anesthetic technique allows for earlier patient recovery and less postoperative pain than a desflurane based technique in ambulatory gynecologic laparoscopic surgery.

REFERENCES

Song D, Van Vlymen J, White P. Is the Bispectral Index useful in Predicting Fast-track eligibility after Ambulatory Anesthesia with Propofol and Desflurane?Anesth Analg 1998;87:1245–8[Abstract/Free Full Text]

Vaghadia H. Spinal Anesthesia for outpatients: controversies and new techniques.Can J Anesth 1998; 45: 64–70

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