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The Use of Endotracheal General Anesthesia with One-minute Pauses in Ventilation to Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy

使用氣管內管全身麻醉術及一分鐘暫停換氣以增加體外震波碎石術的效果

摘要


Objective: Treatment of urinary calculi with extracorporeal shock wave lithotripsy (ESWL) is performed under various types of anesthesia, but is not well tolerated by all patients. Disintegration rates of the calculi with ESWL vary as well, not only because of pain intolerance but due to stone movement during respiration. When the first ESWL procedure fails to fragment the stones, a patient may have to undergo more-invasive procedures such as ureteroscopic lithotripsy (URSL) or percutaneous nephrolithotomy (PNL) which may increase suffering and morbidity. Accordingly, we have developed a more-effective method of anesthesia to control stone movement during ESWL. Materials and Methods: We performed 44 second-time ESWL procedures with endotracheal general anesthesia on 42 patients for whom had failed the first-time ESWL (group A). One-minute pauses of ventilation to hold the stone absolutely still were made to maximize the effectiveness. In the control group, we performed 40 second-time ESWL procedures using intravenous fentanyl anesthesia on 40 patients for whom had failed the first-time ESWL (group B). Results: The average stone movement in group A was 0.78 cm for renal stones and 0.65 cm for upper ureteral stones. With a 1-minute pause in ventilation, the average stone movement was 0.16 cm for renal stones and 0.1cm for upper ureteral stones. In group B, the average stone movement was 1.45 cm for renal stones and 1.03 cm for upper ureteral stones. The disintegration rate was 81.8% in group A and 37.5% in group B (p<0.01). Conclusions: Endotracheal general anesthesia with one-minute pause in ventilation during ESWL can reduce stone movement and increase the effectiveness of ESWL.

並列摘要


Objective: Treatment of urinary calculi with extracorporeal shock wave lithotripsy (ESWL) is performed under various types of anesthesia, but is not well tolerated by all patients. Disintegration rates of the calculi with ESWL vary as well, not only because of pain intolerance but due to stone movement during respiration. When the first ESWL procedure fails to fragment the stones, a patient may have to undergo more-invasive procedures such as ureteroscopic lithotripsy (URSL) or percutaneous nephrolithotomy (PNL) which may increase suffering and morbidity. Accordingly, we have developed a more-effective method of anesthesia to control stone movement during ESWL. Materials and Methods: We performed 44 second-time ESWL procedures with endotracheal general anesthesia on 42 patients for whom had failed the first-time ESWL (group A). One-minute pauses of ventilation to hold the stone absolutely still were made to maximize the effectiveness. In the control group, we performed 40 second-time ESWL procedures using intravenous fentanyl anesthesia on 40 patients for whom had failed the first-time ESWL (group B). Results: The average stone movement in group A was 0.78 cm for renal stones and 0.65 cm for upper ureteral stones. With a 1-minute pause in ventilation, the average stone movement was 0.16 cm for renal stones and 0.1cm for upper ureteral stones. In group B, the average stone movement was 1.45 cm for renal stones and 1.03 cm for upper ureteral stones. The disintegration rate was 81.8% in group A and 37.5% in group B (p<0.01). Conclusions: Endotracheal general anesthesia with one-minute pause in ventilation during ESWL can reduce stone movement and increase the effectiveness of ESWL.

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