EMERGENCY LAPAROTOMIES: VALIDATING THE ROLE OF SPINAL ANESTHESIA IN HIGH RISK CASES. A RETROSPECTIVE, FACILITY BASED OBSERVATIONAL STUDY IN SRINAGAR, GARHWAL, UTTARAKHAND

Introduction: Perforation peritonitis is very rampant in hilly areas of Garhwal due to excessive consumption of alcohol, smoking and stresses of life due to difficult terrain and working conditions. Most of the patients with co-morbities like COPD have higher pulmonary related complications following surgery under G.A. It is a challenge and concern for surgeons and anesthetists to manage and provide optimal care to these patients. The study validates the role of spinal anesthesia in such cases. Materials And Method: We reviewed all cases of emergency laparotomies done between Jan 2019 and June 2020. Ninety cases were given spinal anesthesia as sole anesthetic agent out of which sixty cases were ASA IV and thirty cases were ASA III. Outcome in all cases was analyzed and recorded. Results: All cases were adequately operated and outcome was successful in all accept three cases which required G.A due to prolonged surgeries. None needed mechanical ventilatory support post operatively. Mean hospital stay was seven days and there was no report of major renal or respiratory complications. Conclusion: Spinal anesthesis is a safe option and alternate to G.A in high risk emergency laparotomies minimizing the requirement of ventilatory support in rural tertiary care hospitals were critical care facilities are compromised.