Change of practice due to COVID-19. Is Flexible and Rigid Ureteroscopy for renal and ureteric surgery achievable under spinal anaesthesia?
BAUS ePoster online library. Longshaw A. 06/22/21; 319137; p9-9
Disclosure(s): Nil to declare
Anna Longshaw
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Abstract
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Introduction
During the COVID-19 pandemic our center moved elective operating to an alternative day-case facility where the team performed predominantly spinal anaesthesia (SA).
General anaesthetic (GA) is traditionally preferred to SA for patients undergoing flexible and rigid ureteroscopy as it is difficult to achieve a suitably high block.
SA was deemed a safer form of anaesthetic under COVID conditions due to the risk of aerosol transmission. The anaesthetic team was confident their technique could achieve adequate analgesia.
We trialed SA for all ureteroscopic procedures with the option of converting to GA if surgery could not be achieved safely and comfortably for the patient.
Methods
Over a 3 month period, SA was used as the 1st line anaesthetic option for ureteroscopy cases. We carried out a retrospective observational study of outcomes.
Results
• 41 patients were treated with a conversion rate to GA of 10%(n=4);
• Reasons for conversion – 2 anatomical/ patient factors, 2 inadequate patient analgesia.
• Procedures: Renal Stones 34%(n=14), Upper/ Mid-Ureteric Stones 17%(n= 7), Distal-Ureteric Stones 41%(n=17); Diagnostic 7%(n=3).
• Postoperative complication rate of 22%(n=9) ;
• 4 partial procedures, 4 readmission for sepsis/ residual fragments, 1 overnight admission.
• Average anaesthetic time was 25 minutes (9-44mins)
Conclusion
The global COVID-19 pandemic has led to changes in practice and we have demonstrated that SA is a valuable alternative to GA in the majority of ureteroscopy cases. It does not add significantly to procedure time and the complication rate is comparable to our previous practice.
During the COVID-19 pandemic our center moved elective operating to an alternative day-case facility where the team performed predominantly spinal anaesthesia (SA).
General anaesthetic (GA) is traditionally preferred to SA for patients undergoing flexible and rigid ureteroscopy as it is difficult to achieve a suitably high block.
SA was deemed a safer form of anaesthetic under COVID conditions due to the risk of aerosol transmission. The anaesthetic team was confident their technique could achieve adequate analgesia.
We trialed SA for all ureteroscopic procedures with the option of converting to GA if surgery could not be achieved safely and comfortably for the patient.
Methods
Over a 3 month period, SA was used as the 1st line anaesthetic option for ureteroscopy cases. We carried out a retrospective observational study of outcomes.
Results
• 41 patients were treated with a conversion rate to GA of 10%(n=4);
• Reasons for conversion – 2 anatomical/ patient factors, 2 inadequate patient analgesia.
• Procedures: Renal Stones 34%(n=14), Upper/ Mid-Ureteric Stones 17%(n= 7), Distal-Ureteric Stones 41%(n=17); Diagnostic 7%(n=3).
• Postoperative complication rate of 22%(n=9) ;
• 4 partial procedures, 4 readmission for sepsis/ residual fragments, 1 overnight admission.
• Average anaesthetic time was 25 minutes (9-44mins)
Conclusion
The global COVID-19 pandemic has led to changes in practice and we have demonstrated that SA is a valuable alternative to GA in the majority of ureteroscopy cases. It does not add significantly to procedure time and the complication rate is comparable to our previous practice.
Introduction
During the COVID-19 pandemic our center moved elective operating to an alternative day-case facility where the team performed predominantly spinal anaesthesia (SA).
General anaesthetic (GA) is traditionally preferred to SA for patients undergoing flexible and rigid ureteroscopy as it is difficult to achieve a suitably high block.
SA was deemed a safer form of anaesthetic under COVID conditions due to the risk of aerosol transmission. The anaesthetic team was confident their technique could achieve adequate analgesia.
We trialed SA for all ureteroscopic procedures with the option of converting to GA if surgery could not be achieved safely and comfortably for the patient.
Methods
Over a 3 month period, SA was used as the 1st line anaesthetic option for ureteroscopy cases. We carried out a retrospective observational study of outcomes.
Results
• 41 patients were treated with a conversion rate to GA of 10%(n=4);
• Reasons for conversion – 2 anatomical/ patient factors, 2 inadequate patient analgesia.
• Procedures: Renal Stones 34%(n=14), Upper/ Mid-Ureteric Stones 17%(n= 7), Distal-Ureteric Stones 41%(n=17); Diagnostic 7%(n=3).
• Postoperative complication rate of 22%(n=9) ;
• 4 partial procedures, 4 readmission for sepsis/ residual fragments, 1 overnight admission.
• Average anaesthetic time was 25 minutes (9-44mins)
Conclusion
The global COVID-19 pandemic has led to changes in practice and we have demonstrated that SA is a valuable alternative to GA in the majority of ureteroscopy cases. It does not add significantly to procedure time and the complication rate is comparable to our previous practice.
During the COVID-19 pandemic our center moved elective operating to an alternative day-case facility where the team performed predominantly spinal anaesthesia (SA).
General anaesthetic (GA) is traditionally preferred to SA for patients undergoing flexible and rigid ureteroscopy as it is difficult to achieve a suitably high block.
SA was deemed a safer form of anaesthetic under COVID conditions due to the risk of aerosol transmission. The anaesthetic team was confident their technique could achieve adequate analgesia.
We trialed SA for all ureteroscopic procedures with the option of converting to GA if surgery could not be achieved safely and comfortably for the patient.
Methods
Over a 3 month period, SA was used as the 1st line anaesthetic option for ureteroscopy cases. We carried out a retrospective observational study of outcomes.
Results
• 41 patients were treated with a conversion rate to GA of 10%(n=4);
• Reasons for conversion – 2 anatomical/ patient factors, 2 inadequate patient analgesia.
• Procedures: Renal Stones 34%(n=14), Upper/ Mid-Ureteric Stones 17%(n= 7), Distal-Ureteric Stones 41%(n=17); Diagnostic 7%(n=3).
• Postoperative complication rate of 22%(n=9) ;
• 4 partial procedures, 4 readmission for sepsis/ residual fragments, 1 overnight admission.
• Average anaesthetic time was 25 minutes (9-44mins)
Conclusion
The global COVID-19 pandemic has led to changes in practice and we have demonstrated that SA is a valuable alternative to GA in the majority of ureteroscopy cases. It does not add significantly to procedure time and the complication rate is comparable to our previous practice.
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