Lap Cholecystectomy Questions

[BonnyT]

I have decided to have a lap cholecystectomy as an elective procedure on April 18. Thank you for your previous help with the risk to benefit questions. I am in excellent health,normal wt. for height, and work hard at staying fit and drink lots of water. While I tell my patients that many modern diseases can be avoided by such a lifestyle, it seems I have overstated my case ! I have a single 1.9cm. stone, a single episode of biliary colic and it seems no alternative that is long lasting.  At age 54, what is the best way to avoid the after effects of anesthesia. A friend was recently given a "lemon flavored"med in the preop area and had no nausea after a general anesthesia. Can you tell me which drugs can be given intraopertaively to help prevent nausea? Also, is it possible to be given preop sedatives ect, and the inhalation agent by mask only? I am not worried about the mortality from anesthesia but am not thrilled with the prospect of being intubated. I read a study of some 60 pts. who had epidural only for a lap cholecystectomy with no "untoward effects". Would there be any reason not to do this? After all a C-Section is a major procedure through fat,  muscle and organs , and is commonly done with an epidural. what is the difference with a lap cholecystectomy? Thank you for your help.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Epidural anesthesia for laparoscopic cholecystectomy is not common.  The difference between a C-section and lap chole is that the block needs to be higher.  A high epidural block (T2-T4 levels) is required to abolish the discomfort of surgical stimulation of the upper gastrointestinal structures. The high block produces myocardial depression and reduction in venous return which can add to surgical complications.  Unfortunately, I am not an anethesiologist and you may want to ask your physician team about this option.  

20-30% of patients experience post-operative nausea and vomiting (PONV) after general aneesthesia.  There are many medication options to control this including antihistamines (Benedryl or Atarax), Reglan, benzodiazepines (Ativan), Haldol, Droperidol, steroids, Compazine, Phenergan or Zofran.  Typically these medications are given after surgery since most of them affect blood pressure.  

Here is more information:
http://www.cancernausea.com/ponv/ponv_intro.asp

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[beccabond]

My husband has had three knee surgeries.  With his first two, he had general anesthesia and had terrible episodes with nausea and vomiting the day of and the day after surgery.  With his third, he decided to go for the epidural.  They injected something into his IV to make him VERY relaxed before and during the surgery as well - probably Versed - so he has no memory of the surgery.  Anyway, after the surgery was over, he felt fine - no nausea or vomiting.  Now, I know this doesn't answer your question regarding having your gallbladder removed.  I have been wondering about this question myself because I may have to have my gallbladder removed, and I am not looking forward to the after effects of the general anesthesia.  I've wondered why no one ever mentions having had an epidural with gallbladder removal.

[petespin]

I had a lap cholestectomy last june.  I was given a shot of reglin (sp?) through my IV in the pre-op room to prevent nausea and it worked.  The anesthesiologist will be able to tell you what you will be getting to prevent nausea.  As far as intubation, they did that when I was under and they took the tube out before I awakened in recovery, and all I had was a sore throat for a few days.

[tessa0825]

Bonny, I was given raglan and zantac pre surgery in pill form and when I woke up, I was a little nauseated and when the Dr. (in the recovery rm) asked me how I felt I told him I was nauseated,immediately they gave me something (probably raglan) in my IV that took it away...I then wasnt allowed to have anything (not even water) for the first 24 hrs....As for being intubated I have never (even with my cancer surgeries) had any memory of it...I know it happened but it was after I was asleep and before I woke up......My concern right now is with "versed"  I have every it few months during my EGDs and biopsies, Iam worried I will eventually become addicted to it,if thats even possible.....Good luck Bonny..........Tessa