Page 1

PLAGIARISM SCAN REPORT

Report Generation Date: 22-12-23

Words: 691

Characters: 5006

Excluded URL : N/A

6% 94%
Plagiarism Unique

2 30
Plagiarized Sentences Unique Sentences

Content Checked for Plagiarism

INTRODUCTION
INTRODUCTION
The introduction of laparoscopy in the mid-1950s has revolutionized surgical techniques due to the
reduction of overall morbidity related to surgery like a reduced hospital stay, early recovery. [1] In
comparison to open hysterectomy, total laparoscopic hysterectomy (TLH) is found to be associated
with a reduction in surgical complications like reduced bleeding, reduced overall cost and post-
operative complications, with better postoperative pain score reduced abdominal wall or wound
infection and is associated with faster return to normal activity and shorter hospital stay. [2,3]
Hysterectomy is one of the most frequently performed surgical procedures in the United States (US).
Analysis of the US surgical data between 1998 and 2010 suggests decreasing number of
hysterectomies performed through the abdominal route – from 65% to 54% during this period – in
favour of minimally invasive techniques.[4] Data from National Family Health Survey-4 (2015-16), the
prevalence of hysterectomy operation in India was 3.2% with rural India had a higher prevalence of
hysterectomy operation (3.4%) than urban India (2.7%). [5]
With the increasing acceptance of minimally invasive laparoscopic surgical approaches, the open
abdominal surgeries which were performed under regional anaesthesia (RA) traditionally, went under
the domain of general anaesthesia (GA), thereby, negating some advantages of minimal access
surgery as GA have some disadvantages linked to it. Laparoscopic surgeries are normally performed
under GA with endotracheal intubation to prevent aspiration and respiratory embarrassment
secondary to induction of pneumoperitoneum and also to prevent discomfort and pain due to
stretching of the diaphragm in patients who are awake during the procedure. [6] Increased peripheral
 Page 2
vascular resistance, elevated serum catecholamine level, and decreased cardiac output (CO) in
laparoscopic procedures might entail hemodynamic fluctuation which, in turn, compromises tissue
perfusion. [7] The unopposed increase in systemic vascular resistance (SVR) associated with
pneumoperitoneum has to be managed by increasing anesthetic concentrations and, at times,
administering vasodilators. [8] This eventually leads to unnecessary deepening of anesthesia, delayed
awakening, and does not prove cost effective. [9] In addition, ventilatory impairment and
diaphragmatic dysfunction also occur after laparoscopic surgery. Hence, laparoscopy is only
anatomically minimally invasive but physiologically it is otherwise. [7] Therefore, embracing
laparoscopic surgeries have concomitantly introduced new challenges for anaesthesiologists
demanding changes in anesthesia techniques.
GA as the only suitable technique for laparoscopic procedures is a concept of the past. There is
growing evidence suggesting that RA has an important role to play in the care of patients undergoing
laparoscopic procedures. RA such as epidural and spinal is can be used with GA for laparoscopic
surgery with standard pressure pneumoperitoneum (intraabdominal pressure 12-15 mmHg). [7] A
major abdominal surgery, like TLH, would require adequate depth of anaesthesia along with proper
relaxation and reduction of surgical stress. Operating conditions during laparoscopic surgeries may
be affected by depth of anesthesia and muscle relaxation. [10] RA combined with GA has been
described and successfully used as a technique to attenuate the adverse responses in laparoscopic
surgical procedures. [9,11,12] Combined epidural general anesthesia (CEGA) could match the benefits
of both the techniques without causing any side effects. [13,14] Adding epidural to general anaesthesia
can attenuate the haemodynamic changes associated with pneumo-insufflation by decreasing SVR,
decreasing mean arterial blood pressure (MAP) and maintaining cardiac index as well as it will
decrease the requirements of various anesthetic agents. [13,15] It may provide better haemodynamic
stability when combined with general anaesthesia during laparoscopic surgery. It also improves
surgical field by contraction of bowels due to sympathetic blockade. [15-17] Epidural analgesia in the
postoperative period may improve respiratory function, decrease perioperative cardiac
complications, improve well-being of the patients and facilitate early ambulation as well as return of
bowel function. [17,18]
While there is a plethora of evidences on use of CEGA over GA in laparoscopic cholecystectomy, there
is limited literature available on the efficacy of CEGA in laparoscopic gynaecological surgeries, [19]
more specifically on total laparoscopic hysterectomy. [10] Thus, in the backdrop of limited evidence in
this domain in recent times, especially from the eastern India, the present study was conducted with
the aim to compare the efficacy of CEGA with GA alone in the management of perioperative
haemodynamic events in patients undergoing total laparoscopic hysterectomy.

Matched Sources :

Major laparoscopic surgery under regional anesthesia - NCBI

9%
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388958/
 Page 3
Combined general and epidural anaesthesia for excision ...

https://www.researchgate.net/publication/11641325_Combined_general_and_epidural_anaes 4%
thesia_for_excision_of_phaeochromocytoma--a_unique_and_safe_technique