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首页> 外文期刊>BMC Urology >Reducing kidney motion: optimizing anesthesia and combining respiratory support for retrograde intrarenal surgery: a pilot study
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Reducing kidney motion: optimizing anesthesia and combining respiratory support for retrograde intrarenal surgery: a pilot study

机译：减少肾脏运动：优化麻醉并结合呼吸支持以进行逆​​行肾内手术：一项初步研究

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One of the greatest challenges presented with RIRS is the potential for movement of the stone within the operative field associated with diaphragm and chest respiratory excursions due to mechanical ventilation. To overcome this challenge, we propose in this pilot study a new general anesthesia technique combining high frequency jet ventilation (HFJV) with small volume mechanical ventilation (SVMV). Data regarding safety, feasibility and surgeons’ impression was assessed. Patients undergoing RIRS for kidney stones from November 2017 to May 2018 were prospectively recruited to participate in the study. In each case after the beginning of general anesthesia (GA) with mechanical ventilation (MV) surgeons were asked to assess the mobility of the operative field and conditions for laser lithotripsy according to the developed questionnaire scale. The questionnaire consisted of 5 degrees of assessment of kidney mobility and each question was scored from 1 to 5, 1 being very mobile (extremely poor conditions for dusting) and 5 completely immobile (Ideal conditions for dusting). After the assessment GA was modified with combined respiratory support (CRS), reducing tidal volume and respiratory rate (small volume mechanical ventilation, SVMV) and applying in the same time transcatheter high frequency jet ventilation (HFJV) inside the closed circuit. After beginning of CRS, surgeons were once again asked to assess the mobility of the operative field and the conditions for laser lithotripsy. Main ventilation parameters were recorded and compared in both regimens. A total of 38 patients were included in the study. The mean age was 49 (range 45–53) with a mean stone size of 10?mm (range 10–14) and Hounsfield unit of 1060 (range 930–1190). All patients underwent successful RIRS and no intraoperative complications occurred throughout the duration of the study. A statistically significant difference between ventilation parameters prior to and after CRS institution was detected in all cases, however their clinical impact was negligible. Despite this, assessment via the questionnaire scale point values varied significantly before and after the application of CRS and were 2.3 (2.1; 2.6) and 3.8 (3.7; 4.0) respectively (p??0.001). The novel combined respiratory approach consisting of HFJV and SVMV appears to provide better conditions for stone dusting through reduced respiratory kidney motion and is not associated with adverse health effects or complications. NCT03999255 , date of registration: 25th June 2019 (retrospectively registered).
机译：RIRS面临的最大挑战之一是由于机械通气，结石可能在与diaphragm肌和胸部呼吸短促相关的手术区域内移动。为了克服这一挑战，我们在本实验研究中提出了一种结合高频喷射通气（HFJV）和小体积机械通气（SVMV）的新型全身麻醉技术。评估了有关安全性，可行性和外科医生印象的数据。自2017年11月至2018年5月，接受RIRS肾结石治疗的患者被纳入研究。在每种情况下，在开始全身麻醉（GA）并采用机械通气（MV）的情况下，均要求外科医生根据已开发的调查表规模评估激光碎石术的手术范围和条件。该问卷包括5个评估肾脏活动度的等级，每个问题的评分为1-5，其中1个非常易移动（打扫条件极其恶劣）和5个完全不移动（打扫的理想条件）。评估后，通过联合呼吸支持（CRS）修改GA，减少潮气量和呼吸频率（小体积机械通气，SVMV），并同时在闭路内应用经导管高频喷射通气（HFJV）。开始CRS后，再次要求外科医生评估手术区域的活动性和激光碎石术的状况。记录并比较两种方案中的主要通气参数。该研究总共包括38名患者。平均年龄为49岁（范围45–53），平均石块大小为10？mm（范围10–14），Hounsfield单位为1060（范围930–1190）。所有患者均接受了成功的RIRS，并且在整个研究过程中均未发生术中并发症。在所有情况下，检测到CRS之前和之后通气参数之间的统计学差异均显着，但其临床影响可忽略不计。尽管如此，在使用CRS之前和之后，通过问卷量表分值的评估差异很大，分别为2.3（2.1; 2.6）和3.8（3.7; 4.0）（p <0.001）。由HFJV和SVMV组成的新型组合呼吸方法似乎可通过减少呼吸肾脏运动来提供更好的结石条件，并且与不良健康影响或并发症无关。 NCT03999255，注册日期：2019年6月25日（追溯注册）。

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