Procedural sedation and analgesia for pediatric shock wave lithotripsy: a 10 year experience of single institution

Abstract

The aim of this study was to evaluate anesthesia practice for pediatric extracorporeal shock wave lithotripsy (ESWL) according to the age groups and discuss the anesthetic management of these patients. Pediatric patients treated with ESWL because of urolithiasis under anesthesia in our department between December 2007 and January 2017 were evaluated retrospectively. A total of 251 patients were divided into two groups as Group PS: preschool children (<6 years) and Group S: school children (≥6 years). Groups were compared according to ketamine and midazolam doses, extra anesthetic agent requirement, duration of procedure, procedural and postprocedural complications due to anesthesia, as well as mean number of sessions and calculus diameter. A total of 408 sessions of ESWL were applied to 251 children included in the study. Overall, mean age of the patients was 4.5 ± 3.2 years (7 months-14 years). In school children (Group S), mean ketamine and midazolam doses were significantly higher than the preschool group (p < 0.01 and p = 0.04, respectively). There was no statistically significant difference in additional anesthetic agent requirement (p = 0.35) as well as mean number of SWL sessions (p = 0.23), duration of anesthesia (p = 0.93), stone size (p = 0.20), and stone laterality (p = 0.71) in both preschool and school children. No severe complications were observed in both groups. In pediatric ESWL patients, ketamine-midazolam combination is an effective and safety choice for outpatient anesthesia. Appropriate dose adjustment in a monitorized and well-equipped setting is essential.

The effect of music on state anxiety in patients undergoing extracorporeal shockwave lithotripsy

“…It can be performed under anaesthesia, especially in the paediatric age group. 17 While there is an effective analgesia recommendation in the guidelines, there is no suggestion about anaesthesia. Movement and deep breathing excursion because of pain should be reduced.…”

“…In urology clinics, most ESWL procedures are performed without general anaesthesia or sedation. It can be performed under anaesthesia, especially in the paediatric age group 17 . While there is an effective analgesia recommendation in the guidelines, there is no suggestion about anaesthesia.…”

Neonatal Anesthesia by Ketamine in Rats Interferes with Proliferation and Differentiation of Hippocampal Neural Stem Cells and Neurocognitive Function in Adulthood via Inhibition of Notch1 Signalling Pathway

“…Ketamine is one of the most commonly used anesthetics in sedation, anesthesia and analgesia during pediatric examination and surgical operation [4][5][6] . The studies in rodents, nonhuman primates and clinic suggest that the prolonged and/or repeated ketamine exposure during brain developmental period may evoke neuronal apoptosis and inhibit neurogenesis, leading to neurobehavioral abnormalities in the adulthood [7][8][9][10][11] .…”

Neuroprotective effects of dexmedetomidine against the ketamine-induced disturbance of proliferation and differentiation of developing neural stem cells in the subventricular zone

“…Ketamine is widely used in analgesia and sedative processes during pediatric examination and surgical operation [1][2]. Recently, an increasing number of research have suggested that neonatal ketamine exposure could cause neuroapoptosis and disturb normal neurogenesis in the developing brain and increase the risk of delayed neurocognitive dysfunction [3][4][5][6].…”