Comparison Of Two Anesthesia Methods For Ureteroscopic Lithotripsy With The Holmium Laser For Upper Or Middle Ureteral Calculi

Objective: To estimate the efficacy and safety of general intravenous anesthesia with laryngeal mask airway(LMA) or combined spinal epidural anesthesia(CSEA) when performing ureteroscopic lithotripsy using the holmium laser for upper or middle ureteral calculi, so that to choose a better method of anesthesia for the ureteral calculi patient in clinical treatment. Materials and Methods: A total of 45 patients selected from urinary surgery of Qinghai University Affiliated Hospital from Mar. 2014 to Dec. 2015, which were diagnosed as upper or middle ureteral calculi, were received general intravenous anesthesia with laryngeal mask airway(LMA) before going ureteroscopic lithotripsy using the holmium laser. The group CSEA: 53 patients with upper or middle ureteral calculi were collected retrospectively who had gone ureteroscopic lithotripsy using the holmium laser between 2012 and 2014. Both of the two groups had been signed written informed consent by the patient or family. And the operations were all performed by physician-in-charge above who equipped rich clinical experience. Intraoperative and postoperative kinds of the instruments needed for URL and bladder irrigation fluid and medication of the patients were same. Preoperative 10 min and intraoperative(surgery has began 10 min) the changes of blood pressure and heart rate as well as the time of surgery were noted and compared in the two groups. In addition, operative side-effects and difficulty, rate of success of lithotripsy, patients’ sense of comfort were also noted and compared. Results: 1. During the operation, a significant fluctuation of circulation was observed in the CSEA group, which the blood pressure and heart rates dropped more than those in the LMA group(p<0.05). 2. In the aspect of surgery time, the CSEA group was obviously longer than LMA group(p<0.05). 3. Compared with the CSEA group, the patients in the LMA group had fewer operative side-effects, lower operative difficulty and a higher rate of success(p<0.05). 4. Besides, patients in the LMA group were easy to crush stone thanks to no body move and good breath control; were highly satisfied with the operation without pain memory. Conclusions: As to perform ureteroscopic lithotripsy using the holmium laser for upper or middle ureteral calculi, choosing general intravenous anesthesia with LMA have the following four advantages that be concluded in this research compared with CSEA: 1.The LMA group is more stable circulation(blood pressure and heart rate), more safe and comfortable than the CESA group; 2. The LMA group has no reaction and body movement which are more conducive to the operation than the CESA group; 3. The LMA group is more successful in reducing the rate of the difficulty of operation and upper or middle stones return kidney than the CESA group; 4. The LMA group is more efficient in shortening operative time than the CESA group.Based on its more efficient operation success rate and higher patient satisfaction, the laryngeal mask airway anesthesia is suitable for clinical application when performing ureteroscopic lithotripsy using the holmium laser for upper or middle ureteral calculi.