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World Journal of Surgery

Published in:

01-09-2009

Combined Lumbar Spinal and Thoracic High-Epidural Regional Anesthesia as an Alternative to General Anesthesia for High-Risk Patients Undergoing Gastrointestinal and Colorectal Surgery

Authors: James Skipworth, Attavar Srilekha, Dimitri Raptis, David O’Callaghan, Siri Siriwardhana, Romi Navaratnam

Published in: World Journal of Surgery | Issue 9/2009

Abstract

Objective

A prospective study was undertaken to review the use of combined lumbar spinal and thoracic high-epidural regional anesthesia in high-risk patients who underwent gastrointestinal/colorectal surgery from 2004 to 2006.

Methods

Twelve high-risk patients underwent 13 gastrointestinal/colorectal surgical procedures, using a regional anesthetic technique, which consisted of a thoracic epidural and lumbar subarachnoid block. All patients were classified as high risk based on anesthetic assessment (American Society of Anesthesiologists (ASA) score 3 or 4).

Results

Six (46.2%) of the patients were men, and the overall median age was 86 years. Ten (76.9%) patients presented as emergencies, whereas only three (23.1%) patients underwent elective procedures. All patients subjectively rated their postoperative pain relief as effective. The 30-day mortality was 2 (15.4%); however, both of these patients refused initial treatment. Only one (7.7%) patient required delayed ITU admission for respiratory support (CPAP). None of the patients required intubation at any stage. There were two (15.4%) minor and two (15.4%) major early complications and only one (7.7%) delayed complication to date. Median length of stay was 7 days. Two (15.4%) patients had delayed discharge dates, for social reasons.

Discussion

These patients demonstrated early postoperative recovery, with effective analgesia, no requirements for intubation, and lower morbidity and mortality rates than similar studies of high-risk patients who underwent procedures using general anesthesia. Using this technique, patients were managed appropriately in HDU and the surgical ward, without affecting their overall length of hospital stay.

Conclusions

This study supports the role of regional anesthetic techniques, combined with targeted, minimally invasive surgery—particularly for the management of high-risk patients presenting in the emergency setting.

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Title: Combined Lumbar Spinal and Thoracic High-Epidural Regional Anesthesia as an Alternative to General Anesthesia for High-Risk Patients Undergoing Gastrointestinal and Colorectal Surgery
Authors: James Skipworth
Attavar Srilekha
Dimitri Raptis
David O’Callaghan
Siri Siriwardhana
Romi Navaratnam
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 9/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-009-0134-z

At a glance: The STEP trials

Springer Medicine

Combined Lumbar Spinal and Thoracic High-Epidural Regional Anesthesia as an Alternative to General Anesthesia for High-Risk Patients Undergoing Gastrointestinal and Colorectal Surgery

Abstract

Objective

Methods

Results

Discussion

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Discussion

Conclusions

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