Anesthesiological management of the precise transuretral contact nephrolithotripsy using high-frequency jet ventilation

Abstract

The anesthesia management during contact transurethral nefrolithotripsy (CLT) requires minimizing kidney movements, caused by standard mechanical ventilation (МV) during general anesthesia (GА). Modifying the respiratory support, in particular by adding high-frequency jet ventilation (HFJV), allows decreasing kidney movements during CLT.The objective: to evaluate the possibilities of anesthetic management and surgical conditions during the MV modified with HFJV during kidney stones laser fragmentation under GA.Subjects and methods. The study included 30 patients underwent CLT under GA maintained with sevoflurane. At the stage of lithotripsy, the standard MV was modified and combined with catheter HFJV. ASA basic anesthetic monitoring and the control of patient consciousness level with BIS were performed. Surgical conditions during CLT were evaluated before and after HFJV.Results and discussion. The combination of HFJV with small volume MV makes it possible to provide sufficient sevoflurane end tidal concentration to maintain GA. The indices of ventilation, gas exchange and hemodynamics values remained within the safe ranges. Using HFJV and small volume MV reduces kidney respiratory movements. Surgical assessment during MV with HFJV was significantly better versus standard MV.Conclusions. The use of HFJV with small volume MV during GA with sevoflurane decreases the kidney respiratory movement and allows precise CLT, effective MV and well-controlled anesthesia depth.

Keywords

• high-frequency jet ventilation
• mechanical ventilation
• general anesthesia
• sevoflurane
• transurethral contact lithotripsy