Neuraxial anesthesia for abdominal surgery, beyond the pandemic: a feasibility pilot study of 70 patients in a suburban hospital.
Awake surgery
COVID-19
Colorectal surgery
Complex surgery
Neuraxial anesthesia
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
16
02
2023
accepted:
31
05
2023
medline:
18
8
2023
pubmed:
6
6
2023
entrez:
6
6
2023
Statut:
ppublish
Résumé
The aim of this study is to establish the feasibility of awake laparotomy under neuraxial anesthesia (NA) in a suburban hospital. A retrospective analysis of the results of a consecutive series of 70 patients undergoing awake abdominal surgery under NA at the Department of Surgery of our Hospital from February 11th, 2020 to October 20th, 2021 was conducted. The series includes 43 cases of urgent surgical care (2020) and 27 cases of elective abdominal surgery on frail patients (2021). Seventeen procedures (24.3%) required sedation to better control patient discomfort. Only in 4/70 (5.7%) cases, conversion to general anesthesia (GA) was necessary. Conversion to GA was not related to American Society of Anesthesiology (ASA) score or operative time. Only one of the four cases requiring conversion to GA was admitted to the Intensive Care Unit (ICU) postoperatively. Fifteen patients (21.4%) required postoperative ICU support. A statistically non-significant association was observed between conversion to GA and postoperative ICU admission. The mortality rate was 8.5% (6 patients). Five out of six deaths occurred while in the ICU. All six were frail patients. None of these deaths was related to a complication of NA. Awake laparotomy under NA has confirmed its feasibility and safety in times of scarcity of resources and therapeutic restrictions, even in the most frail patients. We believe that this approach should be considered as an useful asset, especially for suburban hospitals.
Identifiants
pubmed: 37278936
doi: 10.1007/s13304-023-01554-z
pii: 10.1007/s13304-023-01554-z
pmc: PMC10242600
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1691-1697Informations de copyright
© 2023. Italian Society of Surgery (SIC).
Références
COVIDSurg Collaborative (2020) Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 107(11):1440–1449
Grishina A, Link F, Arend A, Kleemann F, Tober-Lau P, Andree D et al (2022) A survey among physicians in surgery and anesthesiology departments after the first surge of SARS-CoV-2 infections in Germany: preparing for further challenges ahead. Wien Klin Wochenschr 134(9–10):361–370
doi: 10.1007/s00508-021-02000-z
pubmed: 35061080
pmcid: 8780051
Klompas M, Baker M, Rhee C (2021) What is an aerosol-generating procedure? JAMA Surg 156(2):113–114
doi: 10.1001/jamasurg.2020.6643
pubmed: 33320188
McIsaac DI, MacDonald DB, Aucoin SD (2020) Frailty for perioperative clinicians: a narrative review. Anesth Analg 130(6):1450–1460
doi: 10.1213/ANE.0000000000004602
pubmed: 32384334
Romanzi A, Galletti M, Macchi L, Putortì A, Rossi F, Scolaro R et al (2020) Awake laparotomy: is locoregional anesthesia a functional option for major abdominal surgeries in the COVID-19 era? Eur Rev Med Pharmacol Sci 24(9):5162–5166
pubmed: 32432781
Romanzi A, Boleso N, Di Palma G, La Regina D, Mongelli F, Milanesi M et al (2021) Awake major abdominal surgeries in the COVID-19 era. Pain Res Manag 2021:8763429
doi: 10.1155/2021/8763429
pubmed: 33688385
pmcid: 7920720
Berry FR (1997) Needle-through-needle technique. Anaesth Intensive Care 25(5):585–586
pubmed: 9352780
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Pryor A (2020) SAGES and EAES recommendations regarding surgical response to COVID-19 crisis. SAGES. https://www.sages.org/recommendations-surgical-response-covid-19/ . Accessed 20 Dec 2021
Zheng MH, Boni L, Fingerhut A (2020) Minimally invasive surgery and the novel coronavirus outbreak: lessons learned in China and Italy. Ann Surg 272(1):e5–e6
doi: 10.1097/SLA.0000000000003924
pubmed: 32221118
Veziant J, Bourdel N, Slim K (2020) Risques de contamination virale des soignants au cours d’une laparoscopie pendant la pandémie de la COVID-19. J Chir Visc 157(3):S60–S63
pubmed: 32322313
pmcid: 7172662
Macfarlane AJR, Harrop-Griffiths W, Pawa A (2020) Regional anaesthesia and COVID-19: first choice at last? Br J Anaesth 125(3):243–247
doi: 10.1016/j.bja.2020.05.016
pubmed: 32532429
Pöpping DM, Elia N, Marret E, Remy C, Tramèr MR (2008) Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg 143(10):990–1000
doi: 10.1001/archsurg.143.10.990
pubmed: 18936379
Rocca A, Porfidia C, Russo R, Tamburrino A, Avella P, Vaschetti R et al (2023) Neuraxial anesthesia in hepato-pancreatic-bilio surgery: a first western pilot study of 46 patients. Updates Surg. https://doi.org/10.1007/s13304-022-01437-9
doi: 10.1007/s13304-022-01437-9
pubmed: 36607598
pmcid: 9817460
Uppal V, Shanthanna H, Kalagara H, Sondekoppam RV, Hakim SM, Rosenblatt MA et al (2021) The practice of regional anesthesia during the COVID-19 pandemic: an international survey of members of three regional anesthesia societies. Can J Anaesth 69(2):243–255
doi: 10.1007/s12630-021-02150-8
pubmed: 34796460
pmcid: 8601752
Coccolini F, Perrone G, Chiarugi M, Di Marzo F, Ansaloni L, Scandroglio I et al (2020) Surgery in COVID-19 patients: operational directives. World J Emerg Surg 15(1):25
doi: 10.1186/s13017-020-00307-2
pubmed: 32264898
pmcid: 7137852
El Boghdady M, Ewalds-Kvist BM (2021) Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: a systematic review of recommendations. Surgeon 19(2):e29–e39
doi: 10.1016/j.surge.2020.07.005
pubmed: 32855070
Francisco CP, Cua IH, Aguila EJ, Cabral-Prodigalidad PA, Sy-Janairo ML, Dumagpi JE et al (2021) Moving forward: gradual return of gastroenterology practice during the COVID-19 pandemic. Dig Dis 39(2):140–149
doi: 10.1159/000511008
pubmed: 32818948
Major AL, Jumaniyazov K, Yusupova S, Jabbarov R, Saidmamatov O, Mayboroda-Major I (2021) Removal of a giant cyst of the left ovary from a pregnant woman in the first trimester by laparoscopic surgery under spinal anesthesia during the COVID-19 pandemic. Med Sci (Basel) 9(4):70
pubmed: 34842760
Major AL, Jumaniyazov K, Yusupova S, Jabbarov R, Saidmamatov O, Mayboroda-Major I (2021) Laparoscopy in gynecologic and abdominal surgery in regional (spinal, peridural) anesthesia, the utility of the technique during COVID-19 pandemic. Medicines (Basel) 8(10):60
doi: 10.3390/medicines8100060
pubmed: 34677489
Vincenzi P, Starnari R, Faloia L, Grifoni R, Bucchianeri R, Chiodi L et al (2020) Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery. Surg Open Sci 2(4):5–11
doi: 10.1016/j.sopen.2020.07.002
pubmed: 32885157
pmcid: 7453121
Spannella F, Giulietti F, Damiani E, Faloia L, Stronati M, Venezia A et al (2020) Thoracic continuous spinal anesthesia for high-risk comorbid older patients undergoing major abdominal surgery: one-year experience of an Italian geriatric hospital. Minerva Anestesiol 86(3):261–269
doi: 10.23736/S0375-9393.19.13896-5
pubmed: 31486624
Dejnirattisai W, Shaw RH, Supasa P, Liu C, Stuart AS, Pollard AJ et al (2022) Reduced neutralisation of SARS-CoV-2 omicron B.1.1.529 variant by post-immunisation serum. Lancet 399(10321):234–236
doi: 10.1016/S0140-6736(21)02844-0
pubmed: 34942101
Seltzer JL, Ritter DE, Starsnic MA, Marr AT (1985) The hemodynamic response to traction on the abdominal mesentery. Anesthesiology 63(1):96–99
doi: 10.1097/00000542-198507000-00015
pubmed: 4014775
Olsen AA, Strandby RB, Nerup N, Ambrus R, Gøtze JP, Svendsen LB et al (2020) Development of a severe mesenteric traction syndrome during major abdominal surgery is associated with increased postoperative morbidity: Secondary data analysis on prospective cohorts. Langenbecks Arch Surg 405(1):81–90
doi: 10.1007/s00423-019-01847-1
pubmed: 31820096
Bajwa SJ, Kaur J (2012) Risk and safety concerns in anesthesiology practice: The present perspective. Anesth Essays Res 6(1):14–20
doi: 10.4103/0259-1162.103365
pubmed: 25885495
pmcid: 4173431
Ko FC (2019) Preoperative frailty evaluation: a promising risk-stratification tool in older adults undergoing general surgery. Clin Ther 41(3):387–399
doi: 10.1016/j.clinthera.2019.01.014
pubmed: 30799232
pmcid: 6585449
Canaslan K, Ates Bulut E, Kocyigit SE, Aydin AE, Isik AT (2022) Predictivity of the comorbidity indices for geriatric syndromes. BMC Geriatr 22(1):440
doi: 10.1186/s12877-022-03066-8
pubmed: 35590276
pmcid: 9118684
Jawa RS, Patel RB, Young DH (2021) Nutritional assessment: a primary component of the multidimensional geriatric assessment in the Intensive Care Unit. Crit Care Clin 37(1):205–219
doi: 10.1016/j.ccc.2020.08.011
pubmed: 33190771
Guay J, Choi PT, Suresh S, Albert N, Kopp S, Pace NL (2014) Neuraxial anesthesia for the prevention of postoperative mortality and major morbidity: an overview of cochrane systematic reviews. Anesth Analg 119(3):716–725
doi: 10.1213/ANE.0000000000000339
pubmed: 24977635
Dohlman LE, Kwikiriza A, Ehie O (2020) Benefits and barriers to increasing regional anesthesia in resource-limited settings. Local Reg Anesth 13:147–158
doi: 10.2147/LRA.S236550
pubmed: 33122941
pmcid: 7588832