Laparosc Endosc Surg Sci . 2017; 24(4): 128-132 | DOI: 10.14744/less.2018.28199

Sedation anesthesia technique using carbon dioxide for the laparoscopic placement of a peritoneal dialysis catheter

Emin Zümrütdal¹, Tuna Bilecik², Sibel Ada³, Tevfik Tolga Þahin², Fatma Ülkü Adam³, Nurten Genç³, Yeþim Yaðbasan⁴, Ihsan Güney⁴, Murat Gündüz^5
1Department of General Surgery, Private EPC Hospital, Adana, Turkey
²Department of General Surgery, Health Sciences University Adana Training and Research Hospital, Adana, Turkey
³Department of Nephrology, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
⁴Department of Anesthesia and Reanimation, Health Science University Adana Training and Research Hospital, Adana, Turkey
⁵Department of Anesthesia and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey

INTRODUCTION: Chronic ambulatory peritoneal dialysis (CAPD) is a cost-effective treatment for patients with end-stage renal disease (ESRD), and several advantages to CAPD have been reported in comparison with hemodialysis. Several techniques have been described for placing the catheter in the abdominal cavity in CAPD. Use of a laparoscopically fixed CAPD catheter is popular, but this technique often requires general anesthesia (GA). Most ESRD patients with concomitant diseases, such as hypertension, diabetes mellitus, and coronary artery disease, are at high risk to undergo GA, which may preclude catheter insertion. Sedation plus local anesthesia (SA) may be an alternative in these patients. To the best of our knowledge, the use of SA with carbon dioxide (CO2) insufflation has not been previously reported with laparoscopic fixation of a CAPD catheter. In this study, the use of SA and GA were compared with CO2 insufflation in the laparoscopic fixation of a CAPD catheter in 18 patients.
METHODS: Between January 2016 and February 2017, 18 patients (GA: n=13; SA: n=5) underwent laparoscopic CAPD catheterization. All of the GA patients were intubated. Intraabdominal pressure was fixed at 14 mmHg. Patients who underwent SA were administered fentanyl in the operation room and midazolam in the preoperative patient room. Prilocaine hydrochloride and lidocaine hydrochloride were used to provide local anesthesia at all identified incision points. Intraabdominal pressure was fixed at 7 mmHg in all patients. There was no need to convert to GA in any patient. The patients were evaluated in terms of demographic data, perioperative parameters, and postoperative complications.
RESULTS: There were no statistically significant differences between the groups in terms of demographic, perioperative, or postoperative complications (p>0.05).
DISCUSSION AND CONCLUSION: We think that SA is a factor of tolerability in laparoscopic surgery and low pressure. SA may be preferred to GA in high-risk ESRD patients with systemic diseases for laparoscopic CAPD catheter placement.

Keywords: Chronic ambulatory peritoneal dialysis, laparoscopic fixated peritoneal dialysis catheter insertion; laparoscopy; sedation anesthesia.

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Sedasyon anestezisi ile CO2 gazý kullanýlarak uygulanan laparoskopik tespitli peritoneal kateter uygulama tekniði

Emin Zümrütdal¹, Tuna Bilecik², Sibel Ada³, Tevfik Tolga Þahin², Fatma Ülkü Adam³, Nurten Genç³, Yeþim Yaðbasan⁴, Ihsan Güney⁴, Murat Gündüz^5
1EPC Hastanesi,genel Cerrahi Kliniði,adana,türkiye
²Saðlýk Bilimleri Üniversitesi Þehir Hastanesi,genel Cerrahi Kliniði,adana,türkiye
³Saðlýk Bilimleri ÜniversitesiÞehir Hastanesi,nefroloji Kliniði,adana,türkiye
⁴Saðlýk Bilimleri ÜniversitesiÞehir Hastanesi,anestezi Ve Reanimasyon Kliniði,adana,türkiye
⁵Çukurova Üniversitesi Týp Fakültesi,anestezi Ve Reanimasyon Kliniði,adana, Türkiye

GÝRÝÞ ve AMAÇ: Sürekli ayaktan periton diyalizi(SAPD) son dönem böbrek yetmezliðinde(SDBY) etkin bir tedavi yöntemidir. SAPD için intraabdominal kaviteye farklý yöntemler ile kateter yerleþtirme teknikleri tarif edilmiþtir. Bu teknikler arasýnda laparospik yöntem birçok çalýþmada öne çýkmaktadýr. Laparoskopik geliþim ile birlikte þu an için en çok tercih edilen yöntem tespitli SAPD kateter uygulamasýdýr.
Bununla birlikte laparoskopik SAPD kateter yerleþtirilmesi genel anestezi gerektirir. SDBY hastalarýnýn çoðu hipertansiyon diabetes mellitus, koroner arter hastalýðý gibi hastalýklar ile birlikte bulunduðu için komorbiditesi yüksek klinik bir tablodur. Bu sebeple komorbiditesi olan bu populasyonda genel anestezi(GA) uygulanmasý yüksek risk taþýr.
Araþtýrmalarýmýzda yapýlan çalýþmalarda sedasyon anestezisi(SA) eþliðinde laparoskopik tespitli SAPD kateteri takýlmasý CO2 insuflasyonu ile birlikte bildirilmemiþtir.
Bu çalýþmada laparoskopik tespitli SAPD kateteri takýlan SA eþliðinde 5 hasta ile GA eþliðinde 13 hasta geriye doðru incelenerek karþýlaþtýrýldý.
SA uygulanan hastalarda GA uygulanan ameliyatlardan yöntem farklýlýðý dýþýnda demografik, perioperatif ve postoperatif komplikasyonlar açýsýndan istatistiksel olarak anlamlý farklýlýk tespit edilmedi.
SDBY hastalarýnda SAPD kateteri yerleþtirilmesi ameliyatýnda SA’nin, sistemik hastalýklarý yüksek risk oluþturan KBY hastalarýnda GA yerine tercih edilebileceðini düþünmekteyiz.
YÖNTEM ve GEREÇLER:
BULGULAR:
TARTIÞMA ve SONUÇ:

Anahtar Kelimeler: laparoskopik, laparoskopik tespitli peritoneal dializ kateteri takýlmasý, sedasyon anestezi, sürekli ayaktan peritoneal dializ

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