Outcome of Emergency Laparotomies Done under Subarachnoid Block. An Observational Study

Background and Aims: Prevalence of smoking and excessive consumption of alcohol is very high in rural parts of Telangana. The common complications due to this habit may lead to the development of COPD in smokers, as well as the development of gastro-duodenal ulcers. Perforation peritonitis is also very rampant in this part of India. It is well-known that smokers and patients with COPD have a higher rate of pulmonary related complications following abdominal surgery. Nonavailability of modern ventilatory facilities and even of Epidural kits at these areas is still a major concern as well as a challenge to the anaesthesiologists in these parts of India. Delayed diagnosis and late referral of abdominal emergencies to the referral centres makes it more difficult to manage and provide optimal care, however, due to poor financial status and critical conditions it is never easy to refer them to tertiary centres with these facilities. This study reviews the utility of spinal anaesthesia in such cases. Methods: We reviewed all cases of abdominal laparotomies conducted during the period of June 2008- May 2010.Total 56 cases were selected who were given spinal anaesthesia as a sole anaesthetic in left lateral position and were chronic smokers with evidence of COPD. 25cases were of ASA grade IV and 31 were grade III. All cases were operated for upper GI perforation peritonitis. The outcome of these cases was recorded and analysed. Results: Intraoperative conditions were adequate with spinal anaesthesia alone for successful completion of the procedure in all cases except 2(1.12%) cases needed GA due to prolong surgical time. None needed mechanical ventilation in the postoperative period, 2 patients developed pneumonia, and mean length of hospital stay was 7 days. There was no report of renal or respiratory insufficiency. Conclusion: Emergency laparotomies can be safely performed under Spinal anaesthesia, making it a safe option and alternative to GA at the centres without modern ventilatory care.