Anaesthesia for extracorporeal shock wave lithotripsy.

Area of Science:

• Anesthesiology
• Urology

Background:

• Extracorporeal shock wave lithotripsy (ESWL) is a common procedure for kidney stones.
• Anesthetic management for ESWL requires careful consideration of patient factors and procedure specifics.

Purpose of the Study:

• To describe anesthetic considerations for patients undergoing ESWL.
• To compare regional anesthesia with general anesthesia for ESWL procedures.

Main Methods:

• Review of anesthetic techniques for ESWL.
• Discussion of regional anesthesia (epidural) versus general anesthesia.
• Consideration of patient transfer, postoperative analgesia, and specific patient populations (e.g., cardiac insufficiency).

Main Results:

• Regional anesthesia with sedation may be preferable to general anesthesia for ESWL.
• General anesthesia with controlled ventilation, muscle relaxation, narcotics, and low-concentration volatile anesthetics is a suitable alternative.
• Epidural anesthesia offers benefits like easier patient transfer and better postoperative pain relief, especially for multi-stage procedures or severe pain during stone passage.

Conclusions:

• Anesthetic choice for ESWL should balance procedure needs with patient benefits.
• Epidural anesthesia, utilizing a 'loss of resistance to saline' technique, can be advantageous for managing pain and facilitating multi-stage treatments.
• Patients with cardiac insufficiency require specialized anesthetic management due to immersion effects on hemodynamics.