Razvojni put anesteziološke tehnike za izvođenje cistoskopije - iskustva tercijerne ustanove - anestezija za cistoskopije

Abstract

Procedural sedation as an anesthesiological method performed in patients who are unable to tolerate the examination. Procedural sedation was defined for clinical situations which require conditions for performing a therapeutic or diagnostic procedure with protected spontaneous breathing, airway reflexes and hemodynamic stability, with absence of anxiety and pain. Endoscopic urological procedures represent a good therapeutic alternative to open surgical methods but with an incomparable advantage in diagnostics. Endoscopy experienced its expansion in the last 20 years as minimally invasive surgery. Cystourethroscopy is one of the most common procedures performed by a urologist. In a patient with an advanced bladder tumor, after examination with a cystoscope, bimanual palpation is performed requiring good muscle relaxation of the anterior abdominal wall. The Clinic for Urology and Nephrology has started with examination under a cystoscope during the sixties years of the last century. Originally without anesthesia condition, cystoscopies were performed under analgosedation conditions since 1980. Due to the length of the examination and the need to perform bimanual palpation examination this anesthetic approach was inadequate. Furthermore, cystoscopies were performed under general anesthesia, with the increasing dose of anxiolytics, followed with depolarizing muscle relaxants and hypnotics. Nowdays, cystoscopies are performed under general anesthesia, with inhalation anesthetic or propofol maintenance, both provided adequate conditions for examination. The changes of the anesthesiological method over time represents one of the testimonies of the evolutionary pharmacologicaly-technologicaly-personnel development of the anesthesiological specialty for the endoscopic procedure, which has not fundamentally and technically changed since the very beginning.