Comparative Study between General Anesthesia and Combined General Anesthesia with Spinal Anesthesia in Laparoscopic Cholecystectomy

Background: The goal of anesthetic management in patients undergoing laparoscopic surgical procedures include management of pneumoperitoneum. Regional anesthesia such as epidural and spinal can be used with general anesthesia (GA) for laparoscopic surgery with standard pressure pneumoperitoneum. Materials and Methods: A total of 60 patients of American Society of Anaesthesiologist physical Grades I or II undergoing laparoscopic cholecystectomy surgeries with standard pressure pneumoperitoneum (intraabdominal pressure = 12-15 mmHg) were randomly divided into 2 groups with 30 patients in each group. Group A underwent the procedure under GA as per preset protocol. Group B underwent the procedure under combined spinal anesthesia (SA) followed by GA. In both the groups, systolic and diastolic blood pressure, heart rate, bradycardia, hypotension, oxygen saturation (SPO 2), and electrocardiography with ST segment analysis were recorded. Patients were enquired about nausea and vomiting, headache, sore throat, transient neurological symptoms, and pain in post-operative area. Carbon dioxide insufflation pressure was 12-15 mmHg. Results: Group B, receiving combined spinal with GA, was more hemodynamically stable as compared to the Group A. All three hemodynamic parameters pulse rate, systolic blood pressure, diastolic blood pressure were elevated throughout the procedure in the GA group. Bradycardia was seen in 2 and hypotension in 5 cases in the Group B group. The surgeons did not find any significant difference in the operating conditions or muscle relaxation between the two groups. Patients in both the groups maintained adequate SPO 2. Post-operative nausea and vomiting was seen in 30% cases in the GA group and in 6.7% in Group B. Post-operative analgesia was better in the Group B for duration of 6-h, after which there was not much difference in both the groups. Conclusion: GA if combined with SA is a feasible, safe and effective alternative to GA alone, providing stable hemodynamics, less neuroendocrine stress response, good surgical conditions, pain-free post-operative period, and minimal post-operative sequel.