RETROSPECTIVE STUDY OF MANAGEMENT OF HIGH RISK PATIENTS FOR LAPARATOMY UNDER SPINAL ANASTHESIA IN RURAL AREA HOSPITAL

Dr.Geeta B.Patel; Dr.Bharat P. Mistry

Volume : VII, Issue : XII, December - 2018

RETROSPECTIVE STUDY OF MANAGEMENT OF HIGH RISK PATIENTS FOR LAPARATOMY UNDER SPINAL ANASTHESIA IN RURAL AREA HOSPITAL

Dr. Geeta B. Patel, Dr. Bharat P. Mistry

Abstract :

Anesthesia for laparotomy is very challenging. If patients associated with some other comorbidities, then it is more challenging situation for anesthetists, particularly those who are working at rural area & only single anesthetist. Choice of anesthesia & anesthetic agent is judicious & must be balanced to maintain all parameters within normal condition. Spinal anesthesia (S/A) for laparotomy as an alternative to general anesthesia (G/A) in high risk patients is very much useful. Prevalence of smoking, alcohol consumption, tobacco chewer & opium addiction is very high in our district (Banaskantha). Common complications due to this habits may lead to COPD, gastric ulcers, chronic opium addict patients may have damaged heart, lungs, liver & ain. It is very common that smoker & patients with COPD have higher risk of pulmonary complications after abdominal surgeries. Spinal anesthesia has been proposed as a means to reduce postoperative complications in both adults & paediatric patients. Nonavailability of modern full working ventilatory facility & I.C.U. at these areas is still a major concern as well as challenge to the practicing anesthesiologists in these parts of India. In this developing world we anesthesiologists who practicing in remote place hospital, has to suffer a lot in practice because of lack of materials, lack of skilled manpower, inadequate machinery, single handed work, shortage of associated staff. Delayed diagnosis & late referral of abdominal emergencies to the district centres make it more difficult to manage & provide optimal care, however, due to poor financial status, critical conditions & no willingness to go to higher centre, it is never been easy to refuse the patients to tertiary centers with these facilities. This study review the utility of spinal anesthesia in such a patients.

We reviewed 170 cases of laparotomy for different abdominal conditions like peptic perforation, intestinal obstruction, perforation peritonitis, huge ovarian cyst, large abdominal mass, obstructed inguinal hernia, stab injury abdomen & blunt injury abdomen with hemo peritoneum. Total 170 cases done under spinal anesthesia (S/A) as a sole anesthetic. All the patients from ASA grade III & IV. Outcome of these cases was analyzed. Intraoperative condition were good with S/A for successful completion of the laparotomy in all the cases. Only 8 Patients who required supplimentation with G/A due to prolonged surgical time or inadequate level of anesthesia block. None of the patients required ventilatory support, ICU admission In postoperative period, as we don‘t have proper recovery room facility for these type of patients. No single mortality was reported. These was no any renal & respiratory insufficiency noted. Hospital stay of all the patients was about 5 to 10 days. Laparotomy safely done under S/A. So S/A for laparotomy is very safe option & good alternative to G/A at the centres without modern ventilatory care unit. S/A could be well indicated in patients having respiratory disease, difficult airway, malignant hyperthermia, single anesthetist, nonavailability of ventilatory support facilities. S/A would be fundamentally very useful in both adult & pediatric patients. Patients with allergic reaction to local anesthetist, local infection, coagulopathy, intracranial hemorrhage were excluded from S/A.