Operative Gynecological Laparoscopy Under Conscious Sedation
Autor: | Fiorella Conti, Maurizio Rosati, Maria Rizzi, Silvia Bramante, Antonella Frattari, Robert A Roman |
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Rok vydání: | 2020 |
Předmět: |
Conscious sedation
050101 languages & linguistics medicine.diagnostic_test business.industry medicine.medical_treatment Sedation 05 social sciences Remifentanil 050105 experimental psychology Tolerability Minimally invasive surgery Paracervical block Laparotomy Anesthesia medicine Case Series Laparoscopy 0501 psychology and cognitive sciences Surgery Local anesthesia medicine.symptom business Propofol medicine.drug |
Zdroj: | JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons |
ISSN: | 1938-3797 1086-8089 |
Popis: | Background and objectives Operative laparoscopy is generally performed under general anesthesia. Local anesthesia and conscious sedation may be useful in select short procedures. In the present study, we evaluated safety and efficacy of operative laparoscopy under conscious sedation. Methods Retrospective observational study evaluating patients undergoing gynecologic laparoscopy. Laparoscopy under conscious sedation was performed for each patient with umbilical direct insertion of a 12-mm port, followed by 2 ancillary ports at 1 cm medially to the anterior superior iliac spine. Conversion to conventional laparoscopy or laparotomy was recorded. Conscious sedation was obtained using Remifentanil and Propofol, administered by an infusion system based on pharmacokinetic and pharmacodynamic models. Local anesthesia was administered at port insertion sites and for paracervical block. Pain intensity was evaluated with the Visual Analog Scale (VAS). Adverse events and drug concentrations throughout the procedure were retrieved. Results Our study population included 166 patients. They underwent laparoscopic unilateral versus bilateral salpingo-oophorectomy, ovarian cystectomy, bilateral salpingo-oophorectomy and omentectomy for a borderline ovarian tumor, myomectomy; or underwent surgery for unexplained infertility evaluation, pelvic pain, staging of ovarian cancer. Mean duration of pneumoperitoneum was 22.3 ± 7.2 min. Rate of conversion to laparoscopy under general anesthesia was 17/166 (10.2%) and there were only 3 cases of patients with low tolerability to the procedure. No severe adverse events occurred. Hospital discharge occurred in all unconverted cases after 6 to 18 h. Conclusions Operative laparoscopy under conscious sedation and local anesthesia appears to be a feasible technique in gynecologic surgery with no adverse patient outcomes. |
Databáze: | OpenAIRE |
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