Spinal Anesthesia as an Alternative to General Anesthesia for Emergency Laprotomies in ASA Grade III And IV Patients. An Observational Study

Background: Prevalence of smoking and excessive consumption of alcohol is very high in rural parts of Telangana. The common complications due to this habit may lead to development of COPD in smokers , as well as development of gastro duodenal ulcers. Perforation peritonitis is also very rampant in this part of India. It is well known that smokers and patients with COPD have higher rate of pulmonary related complications following abdominal surgery. Non availability of modern ventilatory facilities at these areas is still a major concern as well as challenge to the practicing anesthesiologist in these parts of India. Delayed diagnosis and late referral of abdominal emergencies to the referral centers makes it more difficult to manage and provide optimal care, however due to poor financial status and critical conditions it is never easy to refer them to tertiary centers with these facilities. This study review the utility of spinal anesthesia in such cases. Material and Methods: We reviewed all cases of abdominal laprotomies conducted during period of June 2008- May 2010. Total 56 cases were selected who were given spinal anesthesia as a sole anesthetic and were chronic smokers with evidence of COPD. 25cases were of ASA grade IV and 31were grade III. All cases were operated for perforation peritonitis. Outcome of these cases was recorded and analyzed. Results: Intraoperative conditions were adequate with spinal anesthesia alone for successful completion of the procedure in all cases except 2(1.12%)cases needed GA due to prolong surgical time. None needed mechanical ventilation in postoperative period , 2 patients have developed pneumonia, and mean length of hospital stay was 7 days. There was no report of renal or respiratory insufficiency. Conclusion: Emergency laprotomies can be safely performed under Spinal anesthesia, making it a safe option and alternative to GA at the centers without modern ventilatory care.