Ureteroscopy with Lithotripsy

Anesthesia Implications

Position: Supine, arms at side on armboards
Time: 30-60 min (short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Zero
Maintenance Paralytic: No
Lead: Yes

This procedure is often done in combination with ureteral stent placements/exchanges, etc.

Protective eye-wear – surgeon will be typically using a CO2 laser (use clear goggles) for BOTH you and the patient.

Patient Temperature – Especially in cases that are long, the patients temperature can drop substantially due in part to irrigation.

SIRS/sepsis – this is very rare. In some cases, the release of stones can also trigger inflammatory processes and release bacteria. If the patient is tachycardic or hypotensive during the procedure, rule out this possibility.

Large/multiple stones – This could extend the length of the procedure considerably. Make sure to communicate with the surgeon to assess if GETT is the right approach.

Placement of the Stent – this part of the procedure is stimulating, and also typically marks the end of the procedure.

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.