[Anesthesia for extracorporeal lithotripsy in the treatment of renal lithiasis]

Extracorporeal shock wave lithotripsy has become the main technique for treating renal lithiasis. It has many repercussions on anaesthesia. The fundamental technical concepts of lithotriptors are reviewed. The problems due to the different systems (electrohydraulic or piezoelectric--the most widespread in France) are discussed. Electrohydraulic systems, which are more adapted to the treatment of large stones (diameter greater than 2 cm), require the immersion of the patient. As a result, there are analgesic, cardiovascular, respiratory and temperature repercussions on the anaesthetic management of these patients. General anaesthesia is generally more appropriate for this technique. On the other hand, piezoelectric systems are more adapted to the treatment of medium-sized or small calculi (diameter less than 2 cm), and do not require immersion. Anaesthesia is often not required for the use of this technique, but, if necessary, local, regional or general anaesthesia may be used. For either technique, the anaesthetic protocol must be adapted to the patient's and the surgical indications.