Cevik B et al, 2017: Procedural sedation and analgesia for pediatric shock wave lithotripsy: a 10 year experience of single institution.
Cevik B, Tuncer M, Erkal KH, Eryildirim B, Sarica K.
Dr. Lütfi Kirdar Training and Research Hospital, Urology Clinic, Şemsi Denizer caddesi, 34865, Cevizli-Kartal, Istanbul, Turkey.
The aim of this study was to evaluate anesthesia practice for pediatric extracorporeal shock wave lithotripsy (ESWL) according to the age groups and discuss the anesthetic management of these patients. Pediatric patients treated with ESWL because of urolithiasis under anesthesia in our department between December 2007 and January 2017 were evaluated retrospectively. A total of 251 patients were divided into two groups as Group PS: preschool children (>/= 6 years). Groups were compared according to ketamine and midazolam doses, extra anesthetic agent requirement, duration of procedure, procedural and postprocedural complications due to anesthesia, as well as mean number of sessions and calculus diameter. A total of 408 sessions of ESWL were applied to 251 children included in the study. Overall, mean age of the patients was 4.5 ± 3.2 years (7 months-14 years). In school children (Group S), mean ketamine and midazolam doses were significantly higher than the preschool group (p < 0.01 and p = 0.04, respectively). There was no statistically significant difference in additional anesthetic agent requirement (p = 0.35) as well as mean number of SWL sessions (p = 0.23), duration of anesthesia (p = 0.93), stone size (p = 0.20), and stone laterality (p = 0.71) in both preschool and school children. No severe complications were observed in both groups. In pediatric ESWL patients, ketamine-midazolam combination is an effective and safety choice for outpatient anesthesia. Appropriate dose adjustment in a monitorized and well-equipped setting is essential.
Urolithiasis. 2017 Jun 22. doi: 10.1007/s00240-017-0992-z. [Epub ahead of print]
This is an important report on conscious sedation for ESWL treatment in children of a relatively large number of stone patients. The anaesthesia technique primarily used intravenous ketamine and midazolam. Only appr 20% of the cases required addition of other anesthetic agents like propofol or fentanyl and no child required general anesthesia. Retrograde amnesia is a consequence of conscious sedation and obviously helped to maintain this form of anesthesia also in those children requiring a second ESWL (408 sessions in 251 children).