Abstract

Background Laparoscopy is an effective method of implantation for Peritoneal Dialysis (PD) catheters. However, in many centers around the world, Peritoneal Dialysis Catheter (PDC) insertions are done using an open surgical method, associated with greater surgical trauma and longer duration of hospitalization. One of the major drawbacks to the acceptance of laparoscopic insertion is the perceived necessity for General Anesthesia (GA) for this procedure. In this study, we have examined methods of anesthesia for laparoscopic insertion of PD catheters at a major North American center. Methods This retrospective study includes 245 patients with laparoscopic PD catheter insertion from January 2008 to July 2013 at the University Health Network in Toronto. The patients were consigned to Local Anesthesia (LA) and General Anesthesia (GA) depending on their co-morbidity and risk assessment. The LA patients were given intravenous conscious sedation with midazolam, fentanyl and propofol. Hemodynamic fluctuations were managed with small doses of vasopressors or vasodilators during the procedure. Nitrous oxide and carbon dioxide pneumoperitoneum were used for LA group and GA group respectively. Results The age, the exit site position of the catheter, the history of abdominal surgery and co-morbidities such as diabetes and cardiovascular disease in the two groups were significantly different. All patients tolerated the procedure well. Nearly 45% of the patients were given LA, there were more ASA grade IV patients in this group. Ten patients were converted to GA from LA. There were no significant differences in Systolic Blood Pressure (SBP) in the two groups at the beginning of the anesthesia, but during the surgery, the SBP of GA group decreased. There were no significant differences of SPO2 between the two groups. The mean operating time and observation time in the Post-Anesthesia Care Unit (PACU) of the GA group was longer. After arrival in the PACU, the PACU score in GA group was lower than LA group, but there was no difference between the two groups at discharge. Conclusions Both local and general anesthesia for laparoscopic catheter implantation is safe and effective. Older patients, abdominal (as opposed to pre-sternal) exit sites, co-morbidity with diabetes mellitus, and those with higher ASA grade do well with local anesthesia.

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