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8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 1/22
Is ESWL more effective when conducted
compared with
conscious
sedation?
James Ha es
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 2/22
• ’
• ys c ney seases
• Metabolic disorders
8/9/2019 ESWL Anaesthesia
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• Most stones can pass through the urinary
• Medical treatment
• Surgical treatment
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 4/22
Extracorporeal Shockwave Lithotripsy
• treatment of kidney stones
•
Shock waves are created outside the body trave t roug o y t ssues unt t ey t t e denser stones
• The stones break down into sand ‐like articles
and are
easily
passed
in
the
urine
8/9/2019 ESWL Anaesthesia
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• Lithotripters use either x‐rays or ultrasound to
8/9/2019 ESWL Anaesthesia
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• ‐
• Minimum mor i ity
• Associated with pain and discomfort
• Anaesthesia is needed
8/9/2019 ESWL Anaesthesia
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•
• Newer it otripters associate wit ess pain –
sedation is more common
• Benefits to both
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 9/22
•
• Recent post partum
• Currently breastfeeding
• Difficulties during pregnancy with this calculus
8/9/2019 ESWL Anaesthesia
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• showed no pelvicalceal dilation
•
ESWL was commenced under conscious se at on
• She did not tolerate the procedure well
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 12/22
• breastfeeding
•
It is safe to nurse once awake and alert
• B that time the amount of medication in the bloodstream is low enough that the amounts in the milk would not be si nificant
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 13/22
'
T e point at w ic you wa e up a ter genera
anaesthesia is the point where enough of the rug as e t your system t at t no onger as an effect”
8/9/2019 ESWL Anaesthesia
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•
treatment done under general anaesthesia
sedation
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 16/22
•
ESWL treatment between 19 June 1995 and 3
• T e ata was co ecte prospect ve y ut analysed retrospectively
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 17/22
• ,
horn stones or previous interventions in the
excluded
• Stone removal was considered successful if
t e stone was ro en nto ragments sma er than 4mm
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 19/22
•
patients would have been treated successfully
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 20/22
• ,
non stag horn stones without urinary tract
increased success rate for ESWL treatment
• This result is statistically significant, however
urt er researc w e requ re to eterm ne whether it is also clinically significant.
8/9/2019 ESWL Anaesthesia
http://slidepdf.com/reader/full/eswl-anaesthesia 21/22
•
patient factors into account when making this
• T e ene ts t at se at on o ers over genera anaesthesia are small and there is a relatively
sma ncrease rate o success w t genera anaesthesia