The Effect of Regional Anesthesia in the Management of High-risk Abdominal Emergencies During Pandemics

Abstract

The Coronavirus disease-2019 pandemic has shown us that the number of intensive care beds can be severely limited for postoperative care of high-risk patients. This situation has led to the need to develop a perioperative plan without intensive care support in the management of high-risk abdominal emergencies that cannot be postponed. In this case series, we shared our experiences of awake laparotomy under combined spinal epidural anesthesia in four cases in the related patient group. The patients’ age and ARISCAT score median (min-max) values were respectively 73 years (56-85) and 68 (52-74), ASA scores were III, and all were at high risk for pulmonary complications. The probabilities of mortality, serious complications and expected hospital stay were 23% (11-36%), 40% (34-48%), and 15.5 (13.5-19) days. It was planned to operate the patients under combined spinal-epidural anesthesia. Epidural catheters were placed to cover the dermatome range of the planned surgical incision. Spinal anesthesia dose and initial level target was individualized according to the age and hemodynamic status of the patients, and 0.5% heavy-bupivacaine was administered. All patients underwent gastrointestinal resection at different levels, accompanied by anastomosis or stoma opening. The median (min-max) of the surgical times was 155 (120-210) minutes. No new clinical condition requiring intensive care or not in the preoperative period was observed in the service care of any patient. The hospital stay was observed as 7.5 (5-13) days.

Keywords

• covid-19
• epidural anesthesia
• laparotomy
• major abdominal surgery
• pandemic
• regional anaesthesia