Urologic Procedures Anesthetic Implications by MikeJenny

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									Urologic Procedures &
Anesthetic Implications
     Eric Larson, M.D.
 Skegemog Lake




Our Cottage
                  TURP
 Transurethral Resection of the Prostate
 Surgical Procedure: Cystoscope and
  electrocautery
 Positioning: Lithotomy
 EBL: 500ml
 Anesthetic Choice: Spinal vs. General
 Monitoring: Standard
                              TURP
   TURP Syndrome
     – Because of large amounts of irrigation used to clear field,
       significant absorption may take place.
     – Fluid is isoosmotic usually with manitol, glycine and sorbitol so an
       electric charge cannot be conducted.
     – Massive absorption can lower sodium and cause symptoms:
         » N/V
         » Mental Status changes (Na < 120)
         » HTN
         » Seizures
         » Cardiovascular collapse, dysrhythmias (Na <100)
                       TURP
   Spinal Anesthesia
    – Usually not necessary to use epidural
    – Level should be to T9
    – Advantage over general is that it is easier to
      monitor for TURP syndrome with mental
      status.
           Macinac Bridge
(spanning upper and lower peninsulas)
                Prostatectomy
 Two types, simple and radical
 Simple Prostatectomy
    – Incision to enter thru bladder and shell out
      tumor
   Radical Prostatectomy
    – Entire prostate excised using a retropubic or
      perineal approach
             Prostatectomy
 Positioning: Lithotomy (anticipate
  hypotension when returning from
  lithotomy)
 EBL: 500ml (simple), 1500ml (radical)
 Anesthetic choice: All types valid. Usually
  T8-10 for regional depending on incision
  site.
 Monitoring: Standard + Art + CVP
                Prostatectomy
   Complications:
    – Indigo Carmine leads to false oxygen
      saturations, rare allergic reactions with rash +
      bronchoconstriction + hypotension
    – Peroneal nerve injury from positioning
Grand Rapids, MI
                Nephrectomy
   Nephrectomy
    – Simple: Benign diagnoses
    – Partial: Small neoplasms, duplicated collecting
      systems
    – Radical: Renal cell CA, Wilm’s tumors
   Incision: Flank (Simple, Partial, Radical)
    – Dorsal along paraspinous (Simple)
    – Transabdominal (Radical)
                Nephrectomy
   Positioning: Flank (Simple, Partial, Radical)
    – Prone (Simple)
    – Supine (Radical)
 EBL: 500 ml (Simple, radical), 1200 ml
  (Partial)
 Complications: Pneumothorax,
  unrecognized pleural perforation
Macinac Island
                      Cystectomy
   Types: Simple, partial, radical
   Position: Supine
   Incision: Midline, transperitoneal
   EBL: Simple (1000ml), Partial (minimal), Radical
    (1500ml)
   Anesthetic Choice: GA, Epidural, Spinal Requires a T4
    sensory level.
   Monitoring: Standard, art, CVP, + PA Cath
   Collecting System: Ileal conduit or bladder substitution
    – Remember: May cause a non gap metabolic acidosis (bicarbonate
      and potassium losses)
Ileal Conduit
      Extracorporeal Shock Wave
              Lithotripsy
   Position: Supine
   EBL: Minimal
   Anesthetic Choice: GA, regional
   Monitoring: Standard
   Complications: secondary to shock waves
     – Flank ecchymoses
     – Punctate hemorrhages on stomach/bowel
     – Pulmonary damage possible
     – Dysrhythmias (even despite timing of ESWL pulses in cardiac
       refractory period)
     – VQ mismatching from decreased FRC
   Physiological changes: Increased blood pressure, decreased VC, FRC,
    TV
Lake Michigan
             Orchiectomy
 Position: Supine
 EBL: Minimal
 Anesthetic Choice: GA, regional (should
  obtain T6 level)
 Complications: N/V, Failure to void
         Hypospadias Repair
 Position: Supine
 Incision: Ventral penis
 EBL: 50 ml
 Anesthetic choice: GA, caudal, spinal,
  epidural
 Complications: Urinary retention
 Postop Analgesia: Narcotics, caudal,
  NSAIDS
Caudal Block
               References
 Anesthesiologist’s Manual of Surgical
  Procedures, 2nd ed. Jaffe, Richard
 Anesthesia, 5th ed., Miller

								
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