Videoscopic surgery under local and regional anesthesia with helium abdominal insufflation |
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Authors: | J H Crabtree A Fishman |
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Institution: | (1) Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, 9400 East Rosecrans Avenue, Bellflower, CA 90706, USA, US |
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Abstract: | Background: High-risk patients may not be good candidates for laparoscopic surgery due to the metabolic consequences of transperitoneal
absorption of insufflated CO2 gas and the necessity of general anesthesia because CO2 insufflation produces pain. Helium gas is metabolically inert and does not produce pain. Thus it permits an alternative approach
to performing laparoscopic surgery in high-risk patients.
Methods: Laparoscopic cholecystectomy, appendectomy, hernia repair, and peritoneal dialysis catheter procedures were performed under
local or regional anesthesia in high-risk patients utilizing helium gas as the insufflation agent.
Results: Twenty-one patients underwent laparoscopic procedures under local or regional anesthesia. None of the procedures initiated
under local-regional anesthesia required abandonment of the laparoscopic approach or conversion to general anesthesia. There
were no operative or perioperative mortalities. Two incidences of pneumothorax occurred with extraperitoneal hernia repair;
one required a tube thoracostomy.
Conclusions: Helium gas should be considered the agent of choice for intraperitoneal insufflation in high-risk patients not only because
helium avoids the metabolic consequences of CO2 insufflation but also because it permits selected procedures to be performed under local-regional anesthesia. Helium may
be contraindicated for laparoscopic procedures involving extraperitoneal insufflation due to the increased risk for pneumothoraces.
Received: 15 April 1998/Accepted: 25 August 1998 |
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Keywords: | : Laparoscopy — Helium insufflation — Anesthetic technique — Local anesthesia — Spinal anesthesia |
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