Intubation During Gallbladder Surgery
Yes, patients are routinely intubated during gallbladder surgery (cholecystectomy), as general anesthesia with endotracheal intubation is the standard anesthetic approach for this procedure.
Standard Anesthetic Approach
The typical laparoscopic cholecystectomy requires general anesthesia with endotracheal intubation for several critical physiological reasons 1, 2:
- Prevention of aspiration during the procedure, particularly important given the pneumoperitoneum and patient positioning 3, 2
- Management of respiratory compromise from CO2 pneumoperitoneum, which increases PaCO2 and requires controlled ventilation 2
- Accommodation of increased intra-abdominal pressure from insufflation (typically 10-15 mmHg), which impairs diaphragmatic excursion 3, 2
General anesthesia with controlled ventilation is the accepted technique to manage the cardiorespiratory changes associated with pneumoperitoneum creation 2.
Alternative Approaches in Special Circumstances
While intubation is standard, there are rare exceptions in highly selected patients:
Regional Anesthesia (Epidural)
Epidural anesthesia without intubation can be performed in patients with severe chronic obstructive pulmonary disease (COPD) who are high-risk for general anesthesia 3:
- Requires low-pressure pneumoperitoneum (10 mmHg instead of standard 12-15 mmHg) 3
- Patient must breathe spontaneously throughout the procedure 3
- Limited to ASA III-IV patients with severe pulmonary disease where general anesthesia poses prohibitive risk 3
- Shoulder tip pain may occur and require supplemental IV opioid analgesia 3
Local Anesthesia
Mini-cholecystectomy under local anesthesia (open technique, not laparoscopic) has been reported in highly selected patients 4:
- Requires body mass index <24, no acute cholecystitis, and no previous upper abdominal surgery 4
- Uses local anesthetic infiltration combined with IV sedation (fentanyl and midazolam) 4
- Success rate of 95%, with 5% requiring conversion to general anesthesia 4
Clinical Context
These alternative approaches represent exceptions rather than the rule. The overwhelming majority of cholecystectomies—whether laparoscopic or open—are performed under general anesthesia with endotracheal intubation 1, 5, 2, 6. Even outpatient laparoscopic cholecystectomy, which allows same-day discharge in >95% of cases, still utilizes general anesthesia as is typical for outpatient procedures 5.
Important caveat: The physiologic changes from pneumoperitoneum, including increased PaCO2, cardiovascular compromise, and risk of complications such as gas embolism, pneumothorax, and pneumomediastinum, necessitate careful perioperative monitoring and controlled ventilation in the vast majority of patients 2. Anesthesiologists must maintain high vigilance for these complications, which are best managed with endotracheal intubation and controlled ventilation 2.