Anesthesia for Laparoscopic Surgeries in Rural Areas

By Dr. Deepak David Chellappa and Dr. J. Gnanaraj | Published: Oct 2018 Volume: 7

BACKGROUND

Anesthesia is an important consideration in rural areas because of the higher costs and lack of availability [1]. It is a logistic nightmare to get bottled gases and experienced anesthesiologists in rural areas. We look at the various types of anesthesia used for laparoscopic surgeries in rural areas.

TRADITIONAL GENERAL ANESTHESIA

Traditionally Laparoscopic surgeries are performed under General Anesthesia because there is precise control of ventilation to combat the changes caused by carbon dioxide insufflation [2]. Experienced anesthesiologists are required because the pneumoperitoneum causes the following changes [2]

1. Compression of vena cava and less return to the heart if pressures are greater than 15 mm Hg. Blocks, arrhythmias, vagal stimulation because of peritoneal stretch etc., can occur
2. Respiratory changes include reduced lung volumes, basal atelectasis, increased intrapulmonary shunting, raised peak and mean airway pressures
3. Raised intracranial pressures and reduced flow could occur due to hypercapnia and increased abdominal pressures
4. Aspirations, higher blood pressures etc., also are problems as are problems associated with embolism [3]

In rural areas, since experienced anesthesiologists are not available, trained MBBS doctors or specially trained nurses give anesthesia and often use ether and EMO machine for safety and cost considerations. There are hardly any studies regarding the use this anesthesia for laparoscopic surgeries.

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