V07-05 EPIDURAL ANESTHESIA WITHOUT MECHANICAL VENTILATION IN SINGLE-PORT TRANSVESICAL RADICAL AND SIMPLE PROSTATECTOMY

Abstract

You have accessJournal of UrologyCME1 Apr 2023V07-05 EPIDURAL ANESTHESIA WITHOUT MECHANICAL VENTILATION IN SINGLE-PORT TRANSVESICAL RADICAL AND SIMPLE PROSTATECTOMY Ethan Ferguson, Roxana Ramos, Albert Geskin, Jay Chavali, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Albert GeskinAlbert Geskin More articles by this author , Jay ChavaliJay Chavali More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Due to pneumoperitoneum and Trendelenburg positioning, epidural-only anesthesia has a limited role in modern robotic or laparoscopic prostate surgery. Transvesical access in single-port (SP) robotic simple and radical prostatectomy allows for flat patient positioning and avoids the peritoneal cavity by limiting the surgical working space and insufflation to the bladder lumen. We sought to determine if epidural anesthesia without the need for paralysis or mechanical ventilation were feasible in patients undergoing transvesical SP simple and radical prostatectomy. METHODS: Patients previously scheduled for transvesical SP robotic radical or simple prostatectomy were selected and offered epidural or traditional general anesthesia. Exclusions included underlying obstructive sleep apnea, severe pulmonary disease, prior lumbar spinal surgery, or BMI >35. Low thoracic or high lumbar epidural catheters were placed in the preoperative unit prior to transport to the operating room. The transvesical access technique and basic operative steps of SP transvesical radical and simple prostatectomy are demonstrated. RESULTS: A total of 11 patients underwent epidural placement prior to transvesical SP radical (N=6) and simple (N=5) prostatectomy. All cases were completed by a single surgeon without extra ports, open conversion, or conversion to general anesthesia. No surgical interruptions were noted in 8 of 11 cases and all movement-related interruptions were brief and transient. No anesthetic complications were noted. Intraoperative narcotics were completely avoided in 3 patients. No patients required narcotic medications after discharge and there were no unplanned admissions. CONCLUSIONS: Epidural anesthesia without requiring mechanical ventilation is safe and feasible in selected patients undergoing transvesical SP robotic radical and simple prostatectomy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e597 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Roxana Ramos More articles by this author Albert Geskin More articles by this author Jay Chavali More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...