AMSTERDAM -- There are many urological procedures that can be safely performed under conscious sedation. Both patients and clinicians prefer this method of anesthesia.
Canadian researchers found that patients who had undergone various ureteric, urinary, and advanced cystoscopic procedures were more likely to be awake but sedated than before. According to Kapilan Pantchendrabose (MSc), a medical student at the University of Manitoba in Winnipeg. Canada, most patients stated that they would prefer to remain awake but to be sedated if they had to repeat the procedure.
Panchendrabose stated that the current standard for most urologic procedures was to give general or spinal anesthesia to patients. This was reported at the European Association of Urology's (EAU) 2022 Annual Conference. However, there are risks such as adverse side effects, increased wait times and higher operating room costs. Conscious sedation can be used to anesthetic or analgesic relief during certain procedures. It has been used here for many years.
Researchers from the University of Manitoba have previously shown that distal ureteroscopy can be safely performed under intravenous conscious sedation administered by a nurse. They have since expanded the technique to include advanced urologic procedures.
They conducted a prospective cohort study of all patients who received urological procedures under conscious sedation at their facility from June 2021 through August 2021 to determine if they were able to tolerate it and prefer it over general anesthesia.
The procedures included rigid and flexible ureteroscopy, ureteric stent insertions/exchanges, scrotal/penile procedures (hydroceles, testicular biopsies, etc), urethral dilations, and advanced cystoscopic procedures, including bladder biopsies and botox therapy.
All patients were sedated with midazolam, fentanyl or both.
Patients were contacted four to six weeks later to complete a standard tolerability questionnaire.
During the study period, there were 196 procedures that involved conscious sedation. There were no intraoperative complications and the success rate was 96.5%.
The questionnaires were completed by 161 patients within 4 to 6 weeks. 85% of them answered yes to the question asking if they would opt for conscious sedation again in the event of a repeat procedure.
The factors that were significant in deciding to use conscious sedation instead of general anesthesia included older age (odds ratio of 1.049; P =.017) as well as the perception of the surgeon, on a scale of 1-10, of patients' tolerance.
Multivariate analysis showed that neither body mass, sex, prior conscious sedate experience, Charlson coorbidity index, procedure types, drug types, or time of procedure could be used to predict anesthesia choice.
IV conscious sedation can be used for most advanced urologic procedures. Panchrendabose stated that careful patient selection is essential to ensure a successful procedure.
He admitted that there was a selection bias in the study, as surgeons recommended it only to patients they felt were suitable for less intensive anesthesia.
Medscape Medical News was informed by a urologist not involved in the study that he preferred to use local anesthesia plus Nitrous Ox to relax patients during procedures.
"You don’t have to anesthetize patients or use anxiolytics. This allows you to satisfy our premise, safety. It makes the whole process of going in and having a procedure and then coming out easy and stress-free," Fernando Bianco, MD from the Miami Lakes Surgery Center, Florida.
Bianco stated that procedures such as transperineal laser ablation to treat benign prostatic hyperplasia require a perineal block, administering nitrous dioxide, and performing a perineal block. This allows for an average of 25 minutes of "room in, space out" time.
Internal support was provided for the study. Bianco and Panchendrabose reported no financial relationships.
European Association of Urology (EAU), 2022 Annual Meeting: Abstract a0003. This presentation was made July 1, 2022.
Neil Osterweil is an award-winning journalist in the medical field and a regular contributor to Medscape.
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