Is general anaesthesia necessary for URS in women?

Yalçınkaya, Fatma Fatoş; Topaloğlu, Haluk; Özmen, Esra Beşer; Ünal, Selman

doi:10.1007/bf02550853

Cited by 19 publications

(16 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Yalçinkaya et al reported a success rate of 83% in their series with local ureteroscopic lithotripsy [3]. A similar success rate (88%) was reported by Abdel-Razzak et al [5].…”

Section: Discussionsupporting

confidence: 69%

“…Several reports have shown the effectiveness of local ureteroscopic lithotripsy [3,4]. The review of a published series on treatment with ureteroscopy using multiple types of ureteroscopes and intracorporeal lithotripsy devices reveals success rates ranging from 86 to 100% [14][15][16].…”

Section: Discussionmentioning

confidence: 98%

“…Recent reports [3,4] showed that the success rate of ureteroscopic lithotripsy under local anesthesia was comparable with that of general or spinal anesthesia, but only few reports mentioned the degree of pain associated with the procedure [2].…”

Section: Introductionmentioning

confidence: 98%

See 2 more Smart Citations

Ureteroscopic Lithotripsy Under Local Anesthesia and Without Intravenous Analgesia in Adults: Analysis of the Effectiveness and Patient Tolerability of About 100 Patients

Sallami¹,

Dahmani²,

Gammoudi³

et al. 2011

UIJ

View full text Add to dashboard Cite

Objective:We evaluated the feasibility and effectiveness of ureteroscopic lithotripsy for ureteral stones under local anesthesia without any sedation.Methods: Prospectively, ureteroscopic lithotripsy under local anesthesia was performed in 100 patients (45 males and 55 females). A rigid endoscope (8.5 to 11.5 Fr) was used in all cases. Local anesthesia consists of lidocaine jelly in the bladder associated with a penile nerve block in males only, and without any intravenous analgesia.Ureteroscopy was done for stone fragmentation with a double-J catheter insertion in 13 patients. We compared the pain perception during ureteroscopy to that of cystoscopy performed during the same procedure, using a visualanalogue pain scale recorded by the patient. Results:The overall success rate was 82%. The success rates of the upper, mid, and lower ureteral calculi were 71.4%, 72.7%, and 89%, respectively. The success rate was 100% in calculi less than 10 mm, and 80.3% in those more than 10 mm. Postoperatively, 1 patient developed pyelonephritis. We didn't report any cases of ureteral perforation. The mean pain scale score was lower during the ureteroscopy (3.61 [2.2 to 8.5]) than in cystoscopy (4.52 [1.5 to 8] [p <0.001]). Almost all patients tolerated pain well during the procedure. The procedure was interrupted in only 5 patients and was performed later under spinal anesthesia. Postoperative pain was also tolerable in most patients, and only 8 patients required additional analgesics after the procedure. Conclusion:Our findings suggest that most of the patients could tolerate the pain during a rigid ureteroscopic lithotripsy under local anesthesia. This procedure does not increase the risk of complications or compromises the results of treatment. Thus, it may be recommended in carefully selected and informed patients and performed with experienced hands.

show abstract

“…Yalçinkaya et al reported a success rate of 83% in their series with local ureteroscopic lithotripsy [3]. A similar success rate (88%) was reported by Abdel-Razzak et al [5].…”

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Ureteroscopic Lithotripsy Under Local Anesthesia and Without Intravenous Analgesia in Adults: Analysis of the Effectiveness and Patient Tolerability of About 100 Patients

Sallami¹,

Dahmani²,

Gammoudi³

et al. 2011

UIJ

View full text Add to dashboard Cite

show abstract

“…Während sich dies in zahlreichen ausländischen Veröffentlichungen widerspiegelt, in denen die URS als ambulanter Eingriff, in Analgosedierung, in Lokalanästhesie, für Kelchsteine, bei multimorbiden adipösen Patienten, bei Kindern und selbst in der Schwangerschaft untersucht wurde [4,5,6,7,8,22,26,38,39,40], hat die deutsche Gesetzgebung bis zur Einführung der DRGs durch die Finanzierung über die Liegedauer solche Entwicklungen nicht in gleichem Maße gefördert. Deshalb ist es nicht verwunderlich, dass es zur URS in Analgosedierung nur wenige deutsche Veröffentlichungen gibt.…”

Section: Ureterorenoskopieunclassified

“…Yalcinkaya ureteroskopierte 1996 ausschließlich Frauen in Sedoanalgesie und musste nur noch in 2 von 30 Fällen wegen unzureichender Analgesie zur Vollnarkose wechseln (6,7%) [38]. Auch Hosking [17] konnte den deutlichen Unterschied des Schmerzniveaus während der URS zwischen Männern und Frauen zeigen: seine Versagerquote für die Sedoanalgesie lag 1996 bei männlichen Patienten mit 27,8% (10/36) über 4-mal hö-her als die der weiblichen Patienten mit 6,3% (2/32), während in der vorliegenden Remifentanil-Studie die Quote auf 2,9% (4/140) gesamt und 0% (0/57) bei Frauen gesenkt werden konnte.…”

Section: Abb 6 ▲ Vergleich Der Schmerzangaben Von Männern Und Frauenunclassified

Die Ureterorenoskopie in Analgosedierung

2004

View full text Add to dashboard Cite

In a prospective study, from September 2000 to September 2001, all ureteroscopies ( n=140) were performed under local and intravenous patient controlled analgesia using continuous infusion of remifentanil (Ultiva). The dosage of 0.15 micro g/kg/min was adapted to changing intraoperative pain (range 0.08-0.30 micro g/kg/min). Preoperative sedation with midazolam 2 mg was given 5 min prior to ureteroscopy. The efficacy of monitored anesthesia care ("Big MAC") was quantified by the patient using a visual analogue pain scale. A total of 97.1% (136/140) of the procedures were performed and finished under remifentanil. Only four male patients underwent conversion to general anesthesia due to insufficient analgesia. All but one patient would choose remifentanil again for first line anesthesia. Significant differences in pain scale values were noticed for male/female patients and ureteroscopies above/below the iliac vessel crossing. Side effects were rare being mainly hypoxic events (pO(2)<90% in 5.1%). Indication, intraoperative procedure, average surgery time (24 min), complications and primary success rate (96.6/90/63.3% stone free for distal/mid/proximal ureter, respectively) did not differ from the control group under general anesthesia. Ureteroscopies with remifentanil are safe, universally applicable because of refifentanil's organ independent esterase metabolism and as effective as general anesthesia. There is no need for PACU stay for patients due to the ultra-short drug half-life, and therefore remifentanil is cost effective and perfect in an outpatient setting.

show abstract