Major Attila Louis, Jumaniyazov Kudrat, Yusupova Shahnoza, Jabbarov Ruslan, Saidmamatov Olimjon, Mayboroda-Major Ivanna
Femina Gynecology Centre, CH-1205 Geneva, Switzerland.
Department of Obstetrics & Gynecology, University of Fribourg, CH-1700 Fribourg, Switzerland.
Medicines (Basel). 2021 Oct 19;8(10):60. doi: 10.3390/medicines8100060.
laparoscopic surgery is mainly performed in general anesthesia. Symptomatic patients infected with COVID-19 needing surgery are however at higher risk for COVID-19 complications in general anesthesia than in regional anesthesia. Even so, Covid transfection is a hazard to medical personnel during the intubation procedure and treatment drugs may be in shortage during a pandemic. Recovery and hospital stay are also shorter after laparoscopy. Laparoscopy performed in regional anesthesia may have several advantages in limiting Covid.
international literature on the risk of COVID-19 complications development was searched. 3 topics concerning laparoscopic surgery were reviewed: (1) Achievements in laparoscopy; (2) Advantages of regional anesthesia compared to general anesthesia; (3) Feasibility to perform laparoscopy in regional anesthesia in COVID-19 pandemic. The authors reviewed abstracts and full-text articles concerning laparoscopic surgery, gynecology, anesthesia and COVID-19. Studies published in PubMed, Embase, Cochrane Library and found in Google Scholar before 1st FEB, 2021 were retrieved and analyzed.
a total of 83 studies were found, all of them written in English. 17 studies could be found in gynecology and in general surgery about laparoscopy with regional anesthesia. In Covid time only one study compared laparoscopic surgery in general anesthesia to laparotomy and another study laparotomy in general anesthesia to regional anesthesia. Laparoscopy showed no disadvantage compared to laparotomy in Covid pandemic and in another study laparotomy in general anesthesia was associated with higher mortality and more pulmonary complications. Trendelenburg position can be a threat if used by inexperienced personnel and can induce unintended anesthesia of breathing organs. On the other hand Trendelenburg position has advantages for cardiovascular and pulmonary functions. Pneumoperitoneum of low CO pressure is well tolerated by patients.
elective surgery should be postponed in symptomatic Covid patients. In inevitable emergency surgery intubation anesthesia in COVID-19 pandemic is as far as possible to be avoided. In COVID-19 pandemic, regional anesthesia is the preferred choice. The optimum may be the combination of laparoscopic surgery with regional anesthesia. Reducing the pneumoperitoneum is a good compromise for the comfort of patients and surgeons. A special case is gynecology, which needs to be performed in Trendelenburg position to free pelvic organs.
腹腔镜手术主要在全身麻醉下进行。然而，感染新冠病毒且有症状需要手术的患者在全身麻醉下发生新冠并发症的风险高于区域麻醉。即便如此，在插管过程中新冠病毒传播对医护人员来说是一种危害，而且在疫情期间治疗药物可能短缺。腹腔镜检查后恢复时间和住院时间也较短。在区域麻醉下进行腹腔镜手术在限制新冠传播方面可能有几个优势。
检索了关于新冠并发症发生风险的国际文献。回顾了3个与腹腔镜手术相关的主题：（1）腹腔镜手术的成果；（2）与全身麻醉相比区域麻醉的优势；（3）在新冠疫情期间在区域麻醉下进行腹腔镜手术的可行性。作者回顾了关于腹腔镜手术、妇科、麻醉和新冠的摘要和全文文章。检索并分析了2021年2月1日前在PubMed、Embase、Cochrane图书馆发表以及在谷歌学术搜索中找到的研究。
共找到83项研究，均为英文撰写。在妇科和普通外科中可找到17项关于区域麻醉下腹腔镜手术的研究。在新冠疫情期间，仅有一项研究比较了全身麻醉下的腹腔镜手术与剖腹手术，另一项研究比较了全身麻醉下的剖腹手术与区域麻醉。在新冠疫情期间，腹腔镜手术与剖腹手术相比没有劣势，在另一项研究中，全身麻醉下的剖腹手术与更高的死亡率和更多的肺部并发症相关。如果由经验不足的人员操作，头低脚高位可能是一种威胁，并且可能导致呼吸器官意外麻醉。另一方面，头低脚高位对心血管和肺功能有优势。低二氧化碳压力的气腹患者耐受性良好。
有症状的新冠患者应推迟择期手术。在不可避免的急诊手术中，应尽可能避免在新冠疫情期间进行插管麻醉。在新冠疫情期间，区域麻醉是首选。最佳方案可能是腹腔镜手术与区域麻醉相结合。减少气腹对患者和外科医生的舒适度来说是一个不错的折衷方案。特殊情况是妇科，需要在头低脚高位进行以暴露盆腔器官。
