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AWAKE LAPAROSCOPIC SLEEVE GASTRECTOMY UNDER THORACIC EPIDURAL ANESTHESIA: A CLINICAL FEASIBILITY STUDY
Author(s):
Sherif, A.*
Affiliations:
NMC royal hospital, anesthesia and pain managment, kalifa city, United Arab Emirates
ESRA Academy. Sherif A. Sep 13, 2017; 190754
Prof. Dr. Abeer Sherif
Prof. Dr. Abeer Sherif

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Abstract
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Background and Aims:

Bariatric laparoscopic surgery with pneumoperitoneum is commonly performed under general anesthesia; which may increases upper airway collapse risk, pulmonary atelectasis, and postoperative pulmonary complications in this population. With improved surgical techniques and shorter pneumoperitoneum, regional anesthesia may be considered to be a promising alternative to general anesthesia in selected cases. This study evaluate the safety and feasibility of awake laparoscopic sleeve gastrectomy under sole thoracic epidural anesthesia.

Methods:

 After obtaining approval from the institutional medical ethics committee, and written informed consent for each patient, 15 ASA class 11 or 111 patients were allocated to the study. All patients underwent laparoscopic sleeve gastrectomy under sole thoracic epidural anesthesia.

Results:

Laparoscopic sleeve gastrectomy was performed successfully under thoracic epidural anesthesia, with the exception of one patient who required conversion to general anesthesia due to increased respiratory rate, creating difficulty in performing the procedure.

Conclusions:

From the implemented research it was concluded that awake  laparoscopic sleeve gastrectomy under sole thoracic epidural anesthesia seems to be safely feasible, with minimal hemodynamic consequences and excellent patient, and surgeon satisfaction. Such innovation with excellent patient acceptance and lowest cost for our institution may lead to a new standard for ambulatory bariatric surgery and play future role for protocols in bariatric surgery. Further controlled studies is recommended to evaluate efficacy and safety of this technique in high risk surgical patients.   

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