Jonathan Triajie 11.2013.305 2014 December 5thCombined Spinal and General Anesthesia Is Better Than General Anesthesia Alone for Laparoscopic HysterectomyJOURNAL READINGIntroductionCombination of spinal anesthesia (SA) and general anesthesia (GA) techniques in laparoscopic surgeries, especialy in hysterectomy surgery.The aim of this study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability and requirement of inhaled anesthetics, vasodilators, and recovery profile in laparoscopic hysterectomy2Combined Spinal and General Anesthesia3The Outcomes4Material and Methods560 subjects with ASA physical status I/II30 subjects receive SA with GA (group SGA)30 subjects receive plain GA (Group GA)ASA physical status III/IVContraindications to SAPatients refusalExclusion criteriaBaseline Electrocardiogram Heart Rate (HR)Mean Arterial Preasure(MAP)O2 SaturationmonitoringMaterial and Methods (2)6All patients were preloaded with lactated Ringers solution 15 ml/kgSA was given in sitting position with 26 G Quincke needle in L3-L4 interspace using 10 mg of heavy bupivacaine solutionPatients were immediately made supine and the table height was adjusted to reach a spinal level of T6Patients were premedicated with glycopyrrolate 0.2 mg, midazolam 0.03 mg/kg, and fentanyl 1.5 mcg/kg intravenously

7All patients received ondansetron to prevent postoperative nausea and vomiting (PONV)Anesthesia was induced with 2.5 % thiopentone in dose sufficient to abolish eyelash reflexVecuronium 0.1 mg/kg was given to facilitate endotracheal intubationAnesthesia was maintained with nitrous oxide and oxygen mixture (50:50), isoflurane,and vecuroniumWhen inspiratory concentration exceeded, 1 % Injection of Metoprolol 0.1 mg/kg was given in titrated doses to maintain MAP8At the end of the procedure, neuromuscular blockade was reversed with neostigmine 0.05 mg/kg and glycopyrrolate 80 mcg/kg intravenouslyInjection of diclofenac 75 mg was added to last IV fluid for postoperative analgesiaPatients were observed for regression of SA in the postoperative room for the next 2 hoursParameters for Basic Monitoring9Changes in MAP during creation of pneumoperitoneum and thereafter every 15 minutes until closureAverageinspiratory concentration of isofluraneTotal dose of metoprolol requiredMonitoring depth of anesthesia by BISRecovery time (time lapse between closure and extubation)Surgeons satisfaction by numeric rating scale (NRS) from 1 to 10 (10indicating best possible field)Complications in the form of hypotension(MAP20% baseline), bradycardia (HR < 50/min), PONVRegression of SA.

Results10No significant post-spinal hypotension (MAP