Evaluating Patient Tolerability for Urological Procedures Under Conscious Sedation: A Prospective Study.

Area of Science:

• Urology
• Anesthesiology

Background:

• General or spinal anesthesia for urologic procedures can lead to complications, extended wait times, and increased costs.
• Intravenous conscious sedation and local anesthesia present a promising alternative for numerous urologic interventions.

Purpose of the Study:

• To prospectively assess patient-reported tolerability and surgical outcomes of urologic procedures performed under conscious sedation with or without local anesthesia.
• To compare conscious sedation with general anesthesia from a patient's perspective.

Main Methods:

• 196 urologic procedures were conducted between June-August 2021 at a tertiary care hospital.
• Procedures utilized fentanyl, midazolam, or a combination, with data recorded upon completion.
• A standardized questionnaire assessed patient tolerability via telephone 4-6 weeks post-procedure.

Main Results:

• The study achieved a 98.5% success rate with a 0% intraoperative complication rate across 196 procedures.
• 85.6% of patients indicated a preference for conscious sedation over general anesthesia at 4-6 week follow-up.
• Older age and higher surgeon-perceived patient tolerability were significant predictors for opting for conscious sedation again.

Conclusions:

• Physician-directed, nurse-administered intravenous conscious sedation is a viable option for various urologic procedures.
• This method demonstrates minimal risk of perioperative complications, enhancing patient safety and satisfaction.