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MINIMALLY INVASIVE SURGERY AND TYPES OF ANESTHESIA. ARE THERE ALTERNATIVES?

Similar questions patients ask are:
– I will have laparoscopic surgery. What anesthesia will I get?
– In addition to general anesthesia, laparoscopic surgery is also performed with spinal surgery?
– Can I undergo minimally invasive surgery and not “sleep”?

In summary, we could say that, with the current data and the existing experience, all forms of minimally invasive surgery (laparoscopic, robotic, hybrid) are performed exclusively with the administration of GENERAL ANESTHESIA.
The revolution in laparoscopic surgery introduced a new fact to the physiology of the human body, the infusion of gas into a closed cavity in order to expand it to perform an operation. This gas (CO2, carbon dioxide) but also the increased pressure inside the cavity, causes a variety of cardiovascular and respiratory changes, which can be successfully managed by administering general anesthesia. In addition, the increasing introduction of day-surgery laparoscopic surgeries requires a corresponding modification of anesthesia techniques to achieve faster recovery and mobilization of the patient. At the same time, the advancement of anesthesiology and the drugs administered have pushed into innovative safe techniques under the filter of scientific data.
As an alternative, therefore, the AREA RESISTANCE (back, epidural, combined) has been used. More and more studies are being published highlighting the benefits of regional anesthesia such as non-intubation, automatic breathing, better response to surgical stress, minimal nausea and vomiting, effective postoperative analgesia, the lowest rate of deep venous thrombosis and deep vein thrombosis. patient mobilization. However, it is not free from adverse events such as greater hypotension, septal irritation and respiratory distress due to gas infusion, but also greater surgical time due to the restrictions on the pressure of the gas administered for laparoscopy.
The comparative study presents as a safe alternative technique regional anesthesia for minimally invasive surgeries but does not extend to all subcategories of patients or types of surgeries. Therefore, no guidelines have been published for its implementation. The role of the anesthesiologist is primary in choosing the most appropriate technique depending on the patient’s concomitant diseases. It is noted, for example, that there are patients who cannot receive general anesthesia, as in some patients local anesthesia is prohibited.
In conclusion, general anesthesia is the golden rule and the appropriate technique in minimally invasive surgeries, leaving the regional as an alternative in very specialized and unique cases.