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V K Ramteke - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic total extraperitoneal tep inguinal hernia repair under epidural anesthesia a Detailed Evaluation
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Pawanindra Lal, P Philips, K N Saxena, R K Kajla, Jagdish Chander, V K RamtekeAbstract:Background Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is as efficacious as the open Lichtenstein procedure, can be learned with proper training, and causes less postoperative pain, better cosmesis, and earlier return to work. The one major factor preventing the widespread acceptance of TEP is the requirement for general anesthesia (GA). In contrast, open hernia is performed using local or regional anesthesia, thereby having the advantage of quicker recovery, decreased postoperative nausea and vomiting (PONV), fewer hemodyanamic changes, reduced metabolic responses to surgical stress, and better muscle relaxation. This study attempted to evaluate whether laparoscopic TEP can be performed under less invasive anesthesia, such as regional anesthesia, and to determine its feasibility and limitations
M. C. M. Bhat - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic total extraperitoneal (TEP) inguinal hernia repair under epidural anesthesia: a Detailed Evaluation.
Surgical endoscopy, 2007Co-Authors: M. C. M. BhatAbstract:After reading the article, Laparoscopic Total Extraperitoneal (TEP) Inguinal Hernia Repair Under Epidural Anesthesia: A Detailed Evaluation, by Lal et al. [3], we have a few comments and suggestions about the techniques they practice. At our institution, we perform surgical procedures such as off-pump coronary artery bypass surgery, upper abdominal surgeries, and laparoscopic surgeries with the patient under thoracic epidural anesthesia (TEA). We have performed more than 2,000 cardiac surgeries with concomitant use of TEA [2]. We also have performed cardiac surgeries using TEA as the sole anesthetic [1]. In recent months, we have performed a few laparoscopic procedures including cholecystectomy and diagnostic laparoscopy (without endotracheal intubation). We share our experience performing laparoscopic procedures with the patient under TEA. As mentioned rightly by the authors, a block from T6 to L5 is necessary. To achieve a large block via a lumbar epidural procedure, large doses of a local anesthetic agent are required, exposing the patient to the possible hazard of its toxicity. The authors do not mention the quantity of the local anesthetic used to achieve this block. We usually insert a catheter at the thoracic 8 or 9 level. We achieve the required block initially by administering approximately 6 to 8 ml of the said local anesthetic and set up an infusion of the same local anesthetic at a rate of 5 ml/h. Because of the epidural catheter’s proximity to the zone of analgesia, the total amount of local anesthetic we use for a 2-h surgery is about 12 to 15 ml of 0.5% bupivacaine. We are of the opinion that a continuous infusion of local anesthetic is necessary to prevent inadvertent muscle recovery, which makes working conditions suboptimal for the operating surgeon and sometimes may be a cause for conversion to general anesthesia. In our experience, shoulder tip pain seems to be one of the unmanageable hassles during awake laparoscopic surgeries. Unfortunately, the authors do not suggest management of this issue. We have a few suggestions, which include spraying 0.06% bupivacaine on the peritoneum over the diaphragm via one of the ports and ‘‘painting’’ the diaphragm with a gauze piece soaked in the same concentration of bupivacaine. By these maneuvers, the pain can be alleviated to some extent. In our view, shoulder tip pain becomes a cause for conversion to general anesthesia. From our experience of awake cardiac surgical practice, we have learned that a transparent mask can be strapped onto the patient’s face by a harness. This allows us to assess and assist the patient’s ventilation. At times, after insufflation of the peritoneum with carbon dioxide, a few patients experience dyspnea. Administration of continuous positive pressure ventilation may optimize ventilatory parameters (tidal volume and end-tidal carbon dioxide). Application of this mask helps us measure end-tidal carbon dioxide. Some laparoscopic surgeons wish to use a nasogastric tube in situ. It may be prudent to pass it well in advance of surgery rather than to insert it on the operating table. Ultimately, it is needless to mention that the operating surgeon should be able to adapt himor herself to the consequences of spontaneous respiratory movements. We are of the opinion that this technique is not for novices (Fig. 1). M. C. M. Bhat (&) Department of Minimal Access Surgery, Wockhardt Hospitals, Bangalore, India e-mail: chakravarthy@gmail.com
Pawanindra Lal - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic total extraperitoneal tep inguinal hernia repair under epidural anesthesia a Detailed Evaluation
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Pawanindra Lal, P Philips, K N Saxena, R K Kajla, Jagdish Chander, V K RamtekeAbstract:Background Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is as efficacious as the open Lichtenstein procedure, can be learned with proper training, and causes less postoperative pain, better cosmesis, and earlier return to work. The one major factor preventing the widespread acceptance of TEP is the requirement for general anesthesia (GA). In contrast, open hernia is performed using local or regional anesthesia, thereby having the advantage of quicker recovery, decreased postoperative nausea and vomiting (PONV), fewer hemodyanamic changes, reduced metabolic responses to surgical stress, and better muscle relaxation. This study attempted to evaluate whether laparoscopic TEP can be performed under less invasive anesthesia, such as regional anesthesia, and to determine its feasibility and limitations
P Philips - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic total extraperitoneal tep inguinal hernia repair under epidural anesthesia a Detailed Evaluation
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Pawanindra Lal, P Philips, K N Saxena, R K Kajla, Jagdish Chander, V K RamtekeAbstract:Background Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is as efficacious as the open Lichtenstein procedure, can be learned with proper training, and causes less postoperative pain, better cosmesis, and earlier return to work. The one major factor preventing the widespread acceptance of TEP is the requirement for general anesthesia (GA). In contrast, open hernia is performed using local or regional anesthesia, thereby having the advantage of quicker recovery, decreased postoperative nausea and vomiting (PONV), fewer hemodyanamic changes, reduced metabolic responses to surgical stress, and better muscle relaxation. This study attempted to evaluate whether laparoscopic TEP can be performed under less invasive anesthesia, such as regional anesthesia, and to determine its feasibility and limitations
R K Kajla - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic total extraperitoneal tep inguinal hernia repair under epidural anesthesia a Detailed Evaluation
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Pawanindra Lal, P Philips, K N Saxena, R K Kajla, Jagdish Chander, V K RamtekeAbstract:Background Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is as efficacious as the open Lichtenstein procedure, can be learned with proper training, and causes less postoperative pain, better cosmesis, and earlier return to work. The one major factor preventing the widespread acceptance of TEP is the requirement for general anesthesia (GA). In contrast, open hernia is performed using local or regional anesthesia, thereby having the advantage of quicker recovery, decreased postoperative nausea and vomiting (PONV), fewer hemodyanamic changes, reduced metabolic responses to surgical stress, and better muscle relaxation. This study attempted to evaluate whether laparoscopic TEP can be performed under less invasive anesthesia, such as regional anesthesia, and to determine its feasibility and limitations
