Anesthesia for pediatric lithotripsy.
BACKGROUND
We describe 7 years experience of providing anesthesia for children undergoing lithotripsy in a hospital without pediatric inpatient facilities. A pediatric team, including anesthetist, pediatric nurse along with the equipment travel across the city with the patient from the children's hospital. As a high incidence of postoperative vomiting and discomfort was observed, the effect of increasing intraoperative analgesia and the use of antiemetic medication was examined.


METHODS
From 1998 to 2004, 69 children (49 boys and 20 girls) were anesthetized for 120 procedures: 67 extracorporeal shock wave lithotripsy (ESWL) and 53 endosurgical procedures, consisting of percutaneous nephrolithotomy (29), ureteroscopic laser lithotripsy (17) and percutaneous bladder litholapaxy (7). The mean age was 5.4 years (10 months to 13 years) and weight 23.7 kg (7.1-59 kg). ESWL was performed initially with a Wolf Piezolith 2300, and after 1999, a Dornier Compact Delta.


RESULTS
Increased administration of intraoperative analgesia resulted in reduced postoperative analgesia requirements in all the groups, with a significant reduction (P < 0.05) in the endosurgical group. Those who required more postoperative analgesia had more vomiting significantly (P < 0.05).


CONCLUSIONS
For ESWL postoperative pain is dependent on the type of lithotriptor and the resultant stone fragment size created. This study suggests that postoperative vomiting could be reduced more effectively by the increased administration of intraoperative analgesia, than by a single intraoperative dose of an antiemetic drug.
Department of Anaesthesia, Royal Hospital for Sick Children, Edinburgh, UK.
Roderick D
RD
Aldridge
Roland C
RC
Aldridge
Louise M
LM
Aldridge
D000293:Adolescent; D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008096:Lithotripsy / Q000009:adverse effects; D017602:Lithotripsy, Laser; D008297:Male; D009403:Nephrostomy, Percutaneous; D018666:Ureteroscopy; D001743:Urinary Bladder / Q000601:surgery; D014545:Urinary Calculi / Q000601:surgery / Q000628:therapy*
D000777:Anesthetics