RT Book, Section
A1 Littlejohn, James
A1 Reed, Amy J.
A1 Cereda, Maurizio
A2 Longnecker, David E.
A2 Mackey, Sean C.
A2 Newman, Mark F.
A2 Sandberg, Warren S.
A2 Zapol, Warren M.
SR Print(0)
ID 1144132331
T1 Anesthetic Considerations for Genitourinary and Renal Surgery
T2 Anesthesiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071848817
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144132331
RD 2024/04/16
AB KEY  POINTSAnesthetic  management  of  urologic  patients  requires  confidence  with  the  management  of  elderly  patients  who  typically  have  multiple  comorbidities.Surgical  positioning  is  often  complex  and  exposes  the  patient  to  the  risk  of  significant  complications.Most  endourologic  procedures  can  be  safely  accomplished  with  either  general  or  regional  anesthesia.  The  anesthetic  plan  can  be  tailored  to  patient  characteristics  and  individual  preferences.Urologic  cancer  requires  highly  invasive  operations  that  have  a  high  risk  of  complications.  Patients  undergoing  these  procedures  require  thorough  physiologic  monitoring  and  proactive  hemodynamic,  respiratory,  and  analgesic  management.New  oral  anticoagulant  use  is  on  the  rise  for  a  variety  of  conditions  that  afflict  this  patient  population.  Evidence-based  guidelines  regarding  the  perioperative  management  of  these  drugs  and  the  use  of  neuraxial  anesthesia  are  not  established  at  present.  Careful  consideration  and  knowledge  of  up-to-date  literature  should  be  used  in  the  decision  to  perform  neuraxial  procedures  in  these  instances.Recent  enhanced-recovery-after-surgery  (ERAS)  pathways  have  shown  effectiveness  in  reducing  the  morbidity  of  major  operations  such  as  radical  cystectomies.  ERAS  pathways  often  include  (among  other  things)  standardized  anesthesia  plans,  regional  anesthesia,  goal-directed/restrictive  fluid  management  strategies,  and  effective  pain  control.The  transversus  abdominis  plane  (TAP)  block  is  a  fast,  simple,  and  relatively  low  risk  regional  technique  that  allows  sensory  blockade  of  the  anterior  abdominal  wall  after  major  abdominal  surgery.  It  shows  potential  as  an  adjunct  in  a  multi-modal  approach  to  postoperative  pain  management  in  these  patients.Bleomycin  is  a  chemotherapeutic  agent  that  is  often  used  to  treat  recurrent  and  advanced-stage  testicular  cancer.  Postoperative  acute  respiratory  distress  syndrome  has  been  reported  in  these  patients,  likely  due  to  pulmonary  toxicity  of  bleomycin  triggered  by  increased  amounts  of  inspired  oxygen.  Care  should  be  taken  to  limit  the  admixture  of  oxygen  in  these  patients  as  much  as  possible.The  use  of  minimally  invasive  and  robotic  surgery  in  urology  continues  to  increase  rapidly,  both  in  the  United  States  and  worldwide.  These  procedures  may  require  prolonged  pneumoperitoneum  and  head-down  positioning,  which  introduce  additional  clinical  challenges  for  anesthesia  providers.