What is the role of anesthesia in colon resection (colectomy)?

Updated: Apr 05, 2021
  • Author: David E Stein, MD, MHCM; Chief Editor: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

Colectomies are usually performed with general anesthesia. Patients undergoing general anesthesia require intubation because the diaphragm is paralyzed. General anesthesia is the preferred method for performing colectomies because it paralyzes the abdominal-wall musculature, facilitating exposure and retraction of tissue.

An alternative method of anesthesia for performing colectomies is combined spinal-epidural anesthesia. This method may be appropriate for patients with conditions that cause breathing difficulties, such as severe kyphosis, chronic obstructive pulmonary disease (COPD), or restrictive lung diseases. In such patients, the concern of general anesthesia is the possibility of further respiratory failure that might result in prolonged intensive care management and mechanical ventilation. [28, 29]

Combined spinal-epidural anesthesia allows the patient to remain awake and unintubated throughout the entire procedure while eliminating sensation from the field of surgical operation. The fact that the diaphragm is not paralyzed in spinal-epidural anesthesia can be a disadvantage in laparoscopic cases. The pressure exerted on the diaphragm by insufflation can cause great discomfort to the patient. If this discomfort were to become intolerable, the procedure would have to be converted to an open procedure.


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