[Analgosedation, analgesia with remifentanil in incontinence surgery via tension-free vaginal tape].
OBJECTIVE
The tension-free vaginal tape operation (TVT) is a new surgical treatment of stress urinary incontinence in women. The tape has to be placed at the level of midurethra in the left and right paraurethral canal and has to be brought up to the abdominal wall in close contact with the back of the pubic bone with a special needle instrument. The performed anesthesia is decisive for the operative success, because a sufficient analgesia is demanded and, on the other hand, the correct placement and tension of the urethral tape has to be controlled by the patient performing a stress test by coughing and pressing. In this context the opioid remifentanil seems to be specially suitable because of its pharmacologic characteristics.


METHODS
In this retrospective analysis the anesthesia related data of a total of 70 patients undergoing TVT surgery with remifentanil analgesia within one year were reviewed according to their anesthesia protocols.


RESULTS
All patients underwent remifentanil analgesia in combination with local anesthesia. In no case the performed procedure had to be changed. In 7 cases a temporary decrease of the pulsoximetrically measured oxygen saturation to less-than-or-equal 92 % occurred, which could be treated by reduction of the infusion rate of remifentanil or by assisted ventilation. All patients were adequately able to perform the intraoperatively required stress test. 16 patients suffered from nausea and/or vomiting postoperatively.


CONCLUSIONS
Continuous infusion of remifentanil is suitable for the short time profound analgesia needed for the TVT operation because of the pharmacologic characteristics of remifentanil. A antiemetic prophylaxis should be performed with this analgetic regime.
Gottschalk
A
A
Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Germany. andregottschalk@hotmail.com
Freitag
M
M
Burmeister
M-A
MA
Horn
E-P
EP
Standl
T
T
D000368:Aged; D000698:Analgesia; D000701:Analgesics, Opioid / Q000009:adverse effects; D000932:Antiemetics / Q000627:therapeutic use; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D000077208:Remifentanil; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*
D000701:Analgesics, Opioid; D000932:Antiemetics; D010880:Piperidines; D000077208:Remifentanil