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Hemodynamic effects of anesthesia type in patients undergoing laparoscopic transabdominal preperitoneal inguinal hernia repair under spinal vs general anesthesia

  • C. SarakatsianouEmail author
  • S. Georgopoulou
  • G. Tzovaras
  • K. Perivoliotis
  • M.-E. Papadonta
  • I. Baloyiannis
Original Article



General anesthesia has been used as a standard type of anesthesia for laparoscopic inguinal hernia repair by the transabdominal preperitoneal (TAPP) approach, regional anesthesia being occasionally used in high-risk patients. We had previously designed a controlled randomized trial, comparing spinal with general anesthesia in non-high-risk patients undergoing TAPP inguinal hernia repair. Our results suggested that spinal anesthesia offers some advantages in postoperative pain and additional opioid consumption during the early postoperative period. In the context of this trial, hemodynamic effects of each type of anesthesia are presented.


Seventy patients, undergoing elective TAPP inguinal hernia repair were randomized to either general or spinal anesthesia. Data regarding patients’ hemodynamic status during the procedure under general or spinal anesthesia were collected, measuring systolic blood pressure (SBP), diastolic blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR).


There was no significant effect of anesthesia type on systolic, diastolic and mean arterial pressure values after induction of anesthesia and induction of pneumoperitoneum, respectively. There was a significant effect on heart rate values after induction of anesthesia and induction of pneumoperitoneum, respectively.


Spinal anesthesia is as effective as general anesthesia concerning hemodynamic stability and seems to provide a better result in maintaining hemodynamic stability with fewer fluctuations in blood pressure and mild alterations in heart rate values during TAPP inguinal hernia repair.


General anesthesia Spinal anesthesia Laparoscopic inguinal hernia repair Transabdominal preperitoneal (TAPP) repair Hemodynamic changes 


Compliance with ethical standards

Conflict of interest

CS declares no conflict of interest, SG declares no conflict of interest, GT declares no conflict of interest, KP declares no conflict of interest, MEP declares no conflict of interest, IB declares no conflict of interest.

Ethical approval

The study was approved by the Institution Ethics Committee with the registration number of UTH5535/12/11.

Human and animals rights

The research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical principles for Medical Research Involving Human Subjects”.

Informed consent

Patients were informed in detail and informed consent was obtained.


  1. 1.
    Gerges FJ, Kanazi GE, Jabbour-Khoury SI (2006) Anesthesia for laparoscopy: a review. J Clin Anesth 18:67–78CrossRefGoogle Scholar
  2. 2.
    Hayden P, Cowman S (2011) Anaesthesia for laparoscopic surgery. Contin Educ Anaesth Crit Care Pain 11(5):177–180CrossRefGoogle Scholar
  3. 3.
    Sale HK, Shendage VJ, Wani S (2016) Comparative study between general anesthesia and combined general anesthesia with spinal anesthesia in laparoscopic cholecystectomy. Int J Sci Stud 3(11):157–162Google Scholar
  4. 4.
    Sinha R, Gurwara A, Gupta SLaparoscopic (2008) Total extraperitoneal inguinal hernia repair under spinal anesthesia: a study of 480 patients. J Laparoendosc Adv Surg Tech 18:673–677 15CrossRefGoogle Scholar
  5. 5.
    Lau H, Wong C, Chu K et al (2005) Endoscopic totally extraperitoneal inguinal hernioplasty under spinal anesthesia. J Laparoendosc Adv Surg Tech A 15:121–124CrossRefGoogle Scholar
  6. 6.
    Ismail M, Garg P (2009) Laparoscopic inguinal total extraperitoneal hernia repair under spinal anesthesia without mesh fixation in 1,220 hernia repairs. Hernia 13:115–119CrossRefGoogle Scholar
  7. 7.
    Molinelli BM, Tagliavia A, Bernstein D (2006) Total extraperitoneal preperitoneal laparoscopic hernia repair using spinal anesthesia. JSLS 10:341–344Google Scholar
  8. 8.
    Zacharoulis D, Fafoulakis F, Baloyiannis I et al (2009) Laparoscopic transabdominal preperitoneal repair of inguinal hernia under spinal anesthesia: a pilot study. Am J Surg 198:456–459CrossRefGoogle Scholar
  9. 9.
    Sinha R, Gurwara AK, Gupta SC (2009) Laparoscopic cholecystectomy under spinal anes-thesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A 19:323–327CrossRefGoogle Scholar
  10. 10.
    Imbelloni LE, Fornasari M, Fialho JC, Sant’Anna R, Cordeiro JA (2010) General anesthesia versus spinal anesthesia for laparoscopic cholecystectomy. Rev Bras Anestesiol 60:217–227Google Scholar
  11. 11.
    Tzovaras G, Fafoulakis F, Pratsas K et al (2006) Laparoscopic cholecystectomy under spinal anesthesia: a pilot study. Surg Endosc 20:580–582CrossRefGoogle Scholar
  12. 12.
    Tzovaras G, Zacharoulis D, Georgopoulou S et al (2008) Laparoscopic ventral hernia repair under spinal anesthesia: a feasibility study. Am J Surg 196:191–194CrossRefGoogle Scholar
  13. 13.
    Tzovaras G, Fafoulakis F, Pratsas K et al (2008) Spinal vs general anesthesia for laparoscopic cholecystectomy: interim analysis of a controlled randomized trial. Arch Surg 143:497–501CrossRefGoogle Scholar
  14. 14.
    Sarakatsianou C, Georgopoulou S, Baloyiannis I et al (2017) Spinal versus general anesthesia for transabdominal preperitoneal (TAPP) repair of inguinal hernia: Interim analysis of a controlled randomized trial. Am J Surg 214:239–245CrossRefGoogle Scholar
  15. 15.
    Dong Y, Peng C-YJ (2013) Principled missing data methods for researchers. Springer Plus 2:222CrossRefGoogle Scholar
  16. 16.
    Sood J, Jain AK (2009) Anaesthesia for laparoscopic surgery, 1st edn. Jaypee Publications, IndiaGoogle Scholar
  17. 17.
    Bajwa SJ, Kulshrestha A (2016) Anaesthesia for laparoscopic surgery: general vs regional anaesthesia. J Min Access Surg 12:4–9CrossRefGoogle Scholar
  18. 18.
    Collins LM, Vaghadia H (2001) Regional anesthesia for laparoscopy. Anesthesiol Clin N Am 19(1):43–45CrossRefGoogle Scholar
  19. 19.
    Gutta CN, Oniub T, Mehrabia A et al (2004) Circulatory respiratory complications of carbon dioxide insufflation. Dig Surg 21:95–105CrossRefGoogle Scholar
  20. 20.
    Veekash G, Liu Xin Wei LX, Su M (2010) Carbon dioxide pneumoperitoneum, physiologic changes and anesthetic concerns. Ambul Surg 16(2):41–46Google Scholar
  21. 21.
    Van Zundert AA, Stultiens G, Jakimowicz JJ et al (2006) Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease. Br J Anaesth 96:464–466CrossRefGoogle Scholar
  22. 22.
    Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, Lamy ML (1993) Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg 75:1067–1071Google Scholar
  23. 23.
    Sood J, Kumra VP (2003) Anaesthesia for laparoscopic surgery. Indian J Surg 65:232–240Google Scholar
  24. 24.
    Sinha R, Gurwara AK, Gupta SC (2009 Jun) Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A 19(3):323–327CrossRefGoogle Scholar
  25. 25.
    Neudecker J, Sauerland S, Neugebauer E et al (2002) The EAES clinical practice guidelines on pneumoperitoneum for laparoscopic surgery. Surg Endosc 16:1121–1143CrossRefGoogle Scholar
  26. 26.
    Branche PE, Duperret SL, Sagnard PE, Boulez JL, Petit PL, Viale JP (1998) Left ventricular loading modifications induced by pneumoperitoneum: a time course echocardio-graphic study. Anesth Analg 86:482–487CrossRefGoogle Scholar
  27. 27.
    Magrina JF (2002) Complications of laparoscopic surgery. Clin Obstet Gynecol 45:469–480CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity Hospital of LarissaLarissaGreece
  2. 2.Department of SurgeryUniversity Hospital of LarissaLarissaGreece

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