Clinical Outcomes in Adult Patients Undergoing Laparoscopic Surgery Under Neuraxial Anesthesia

BACKGROUND Laparoscopic abdominal surgery has historically required general anesthesia. However, the use of general anesthetics has neurological effects, including the risk of postoperative neurological disorders. Cognitive impairments (amnesia, cognitive delay, postoperative cognitive dysfunction, difficulty in resuming daily activities) occur in variable percentages of patients based on the type and dosage of anesthetics, duration of exposure, cerebral perfusion pressure, baseline cognitive status, and patient age. Mechanical ventilation during general anesthesia often leads to lung atelectasis, compounded by reduced diaphragmatic excursion due to laparoscopic insufflation, potentially impacting tissue oxygenation and leading to postoperative complications. General anesthetics also have negative inotropic and chronotropic effects, affecting tissue perfusion and increasing the risk of neurological and surgical complications and cardiovascular events.

The increasing complexity of surgical techniques and patient comorbidities necessitates exploring alternatives to general anesthesia, particularly for fragile patients undergoing laparoscopic abdominal surgery. Regional anesthesia techniques have been advocated to provide effective anesthesia while minimizing neurological, cardiovascular, and respiratory impacts, thereby improving clinical outcomes and functional recovery.

RATIONALE Given the significant impact of anesthesia on postoperative complications in fragile patients undergoing laparoscopic abdominal surgery, we aim to develop an anesthetic strategy that optimizes clinical and functional outcomes, especially in terms of preserving neurocognitive and respiratory function, by reducing reliance on general anesthetics. This has led us to reconsider regional anesthesia as an alternative during laparoscopic abdominal surgery.

STUDY DESIGN This is a retrospective observational cohort clinical study, monocentric, with analysis of previous months (following acquisition of study consent) and follow-up.

Each patient underwent preoperative evaluation with a standard anesthesiology visit based on national and international guidelines (SIAARTI-ERAS-ESC). Additionally, preoperative neurologic status was assessed using the Mental Test, delirium assessment with NU-Desc, and Frailty Scale. Lung ultrasound assessment was routinely performed on the day of surgery (see attached assessment scores) before the start of anesthesia procedures and again 2 hours after surgery completion. Patients were sedated with non-GABAergic anesthetics, targeting RASS 0/-2.