Common Urological procedures Flashcards

1
Q

What is a cytoscopy?

What kind of surgeries are done under cystoscopy?

A
  • Most commonly performed urologic procedure
  • Passing a rigid scope through the urethra into the bladder
  • indicated for:
    • hematuria
    • recurrent urinary infections
    • urinary obstruction
  • other surgeries performed under cysto include:
    • bladder biopsies
    • extraction of renal stones
    • placement of renal stent
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2
Q

What are endoscopy procedures?

A
  • visualized the ureter, kidney, bladder, prostate, and ureter
  • Dx and Tx for renal calculi, hematuria, trauma, cancer
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3
Q

What is the anesthetic technique for cystoscopy?

A
  • usually GA
    • procedure is short (15-20 minutes)
    • most pts apprehensive
    • LMA
  • regional
    • spinal preferred (faster onset)
    • no need to wait for spinal to set to move to lithotomy position
  • 2% lidocaine jelly can be used on scope
  • regional or GA for discomfort caused by bladder distension
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4
Q

What level regional do you need for cystoscopy?

spinal dose:

lumbar epidural dose

A
  • T8-T10
  • Spinal
    • 0.75% bupivacaine 10-12 mg if >1hr
    • 0.75% bupivacaine 7.5 mg if <1 hr
  • Lumbar epidural
    • 1.5-2% lidocaine with epi 15-25 ml
    • supplement with 5-10 ml bolus as needed
  • **dont need to know doses for this exam
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5
Q

What is the issue with regional anesthesia for a cystoscopy?

A
  • does not abolish the obturator reflex, which may be stimulated when the electrocautery gets touches the nerve which is close tothe bladder wall
  • causes external rotation and adduction of thigh
  • Obturator reflex can be blocked only by muscle paralysis
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6
Q

What is the TURP procedure done for?

how?

A
  • to alleviate urinary obstruction from BPH
  • most common GU surgery for men >60
  • Done with resectoscope inserted into the urethra/bladder which allows for capability of both cutting and coagulation of tissue and vessels
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7
Q

What are the different types of TURPS?

A
  • M-Turp (monopolar)- traditional, uses electric current
    • cannot have ions in fluid
    • pt becomes hyponatremic
  • B-turp (bipolar)- keeps current contained to unit
    • can use NS for fluid
    • pt can still become ofluid overloaded
  • L-Turp (laser)- lithotripsy
    • can use NS
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8
Q

What are problems that can be caused by the absorption of fluid from the irrigation during a TURP?

A
  • pulm edema
  • hyponatremia
  • cardiac and retinal toxic effects
  • increased blood volume
  • hyperglycemia
  • turp syndrom- neurologic changes from hyponatremia
  • hypothermia- warm fluids
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9
Q

Anesthetic technique

position

pre-op meds

abx

ebl

A
  • Lithotomy with slight trendelenburg
  • pre-op sedation as needed for anxiety
  • Abx per surgeion, usually Gentamycin 80 mg IV slowly
  • EBL about 500 mls
    • EBL is 2-4 ml/min of resection time
    • consider type and cross
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10
Q

Should you do general or spinal for a TURP?

A
  • No difference in outcomes between GA and spinal
  • Spinal is technique of choice for an M-turp so you can monitor their neuro status
    • also allows for recognition of bladder perforation
    • reduces opst-op venous thrombosis
    • reduces intra-op blood loss
  • General- difficult to notice turp syndrome
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11
Q

What is TURP syndrom?

A
  • Caused by absorption of the irrigation solutions
  • can lead to hyponatremia
  • some solutions have glycine in them, which is an inhibitor neurotransmitter
  • Presents as HA, confusion, cyanosis, dyspnea, arrhythmias, hypotension, bradycardia, sz
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12
Q

How can TURP syndrome be prevented?

A
  • Hang irrigating solution no higher than 60 cm above surgical table
  • amt of irrigating fluid absorbed is proportional to surgical time
    • approx 20 ml/min of resection time
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13
Q

How is TURP treated?

A
  • early recognition
  • fluid resitriction
  • loop diuretic
  • hypertonic solution if hyponatremia present
    • 100 ml 3% Saline over 1-2 hrs
    • Ideally pts Na is >120
  • treat sz with midaz, propofol, or phenytoin
    • if glycine used, try magnesium
  • intubate if necessary
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14
Q

What is ESWL?

What is 1st generation vs 3rd generation

A
  • extracorporal shock wave lithotripsy
    • disintigrates calculi in kidneys or upper 2/3 of ureters
    • shock waves focused on the calculi
  • 1st generation- high energy units; pt was submerged in H2O
  • 2nd and 3rd generation- low energy; no water bath
    • use a small water-filling coupling device instead and tightly focused sound beam
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15
Q

ESWL

How is the procedure related to the pts HR?

A
  • Shock waves are synchronized to 20 ms after R wave
    • during ventricular refractory period
  • bradycardia can prolong the procedures
  • pts with pacemaker or AICD are at risk of developing arrhythmias
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16
Q

What is important when managing the anesthesia for an ESWL procedure?

A
  • Immobilization
  • Can use GA or regional
  • GA
    • controlled ventilation (smaller TV, less chance of lungs getting in way of US)
    • prevents pt exposure to loud noise
  • Regional
    • flank infiltation and IC block with MAC ok with 3rd generation, newer lithotripters
    • continuous epidural
    • cannot control diaphragm
17
Q

Regional for ESWL

A

T6 sensory level requires

Flank infiltation and IC block with MAC ok with 3rd generation, newer lithotripters

continuous epidural- avoid injecting air because it can cause sound waves to disperse and damage nearby tissues

cannot control diaphragm

18
Q

When would you use MAC for ESWL?

A
  • For low energy lithotripsy
  • propofol with midaz and opioid
  • avoid movement!!