As hospital resources are becoming strained, ambulatory surgical centers and day hospitals are being increasingly utilized. For the urologist, a working knowledge of local anesthetics and conscious sedation protocols are important, as many surgical kidney-stone procedures can be performed without general anesthetic. With any anesthesia, the key goal is to maximize patient comfort while minimizing respiratory depression and avoiding prolonged sedation. When using these medications, a working knowledge of emergency reversal, ventilation (bag mask/laryngeal mask airway/intubation), and cardiopulmonary resuscitation is recommended.
Key points
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A working knowledge of local anesthetics and conscious sedation protocols is important, as many surgical kidney-stone procedures can be performed without general anesthetic.
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Preoperative urinalysis and culture should be routine for patients undergoing genitourinary surgical manipulation, and overt urinary tract infections should receive a full treatment course of culture-specific antibiotics.
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Shockwave lithotripsy can be performed effectively with conscious sedation.
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If a fragment is known to be left behind or is detected on imaging, knowing its significance will help guide management.
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Postoperative protocols for imaging and second-look nephroscopy are surgeon specific, and can range from no imaging/intervention to routine computed tomography and/or nephroscopy.
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Ureteroscopy has become an indispensable tool for the urologist for both the diagnosis and treatment of benign and malignant urologic conditions.
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Patient selection remains a critically important consideration when determining whether to proceed with ureteroscopy and laser lithotripsy under conscious sedation in an ambulatory setting.
As hospital resources are becoming strained, ambulatory surgical centers and day hospitals are being increasingly utilized. For the urologist, a working knowledge of local anesthetics and conscious sedation protocols are important, as many surgical kidney-stone procedures can be performed without general anesthesia (GA). With any anesthesia, the key goal is to maximize patient comfort while minimizing respiratory depression and avoiding prolonged sedation. When using these medications, a working knowledge of emergency reversal, ventilation (bag mask/laryngeal mask airway/intubation), and cardiopulmonary resuscitation is recommended.
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