Why the study?
General anesthesia with low ventilation may reduce renal mobility and improve retrograde intrarenal surgery performance compared with standard ventilation, but this has not been prospectively studied.
Does general anesthesia with low ventilation improve surgical performance endpoints in patients undergoing retrograde intrarenal surgery compared to standard ventilation?
RCT (n=60)
1:1
No
Does general anesthesia with low ventilation improve surgical performance endpoints in patients undergoing retrograde intrarenal surgery compared to standard ventilation?
Low ventilation during general anesthesia for retrograde intrarenal surgery improves surgical performance and effectiveness, particularly for in-training endourologists, without compromising patient safety.
Supports low ventilation during general anesthesia for retrograde intrarenal surgery to improve efficiency, especially for fellows; extends RCT evidence on anesthesia optimization.
Introduction: We set out to investigate whether general anesthesia with low ventilation (LV, respiratory rate ≤8/minute and tidal volume <500 mL) could reduce renal mobility and thereby facilitate improved retrograde intrarenal surgery (RIRS) compared with general anesthesia with standard ventilation (SV). Materials and Methods: All 60 consecutive patients who presented for RIRS in our department from September 1, 2017 to December 31, 2017 were prospectively randomized 1:1 into one group that was selected to receive SV and another that received LV. Significant factors influencing the study endpoints considered fragmentation rate (FR), removal rate (RR), processing rate (PR), and operating rate (OR), were statistically analyzed for the whole group as well as for comparison by level of surgeon expertise. Results: Univariate analysis revealed that LV was a significant factor in improving all endpoints. Some endpoints were also affected by the stone's volume, number, and density as well as the surgeon expertise. LV remained the single independent factor for FR, RR, and PR in the multivariate analysis. LV significantly improved all four of the fellows' endpoints (p < 0.05 for each) and positively influenced the expert's RR (p = 0.04), PR (p = 0.02) and OR (p = 0.04). The performance gap between the fellows and the experts narrowed under LV. The end-tidal CO2 was significantly higher in the LV group (50 vs 36 mm Hg; p < 0.0001), however, without any clinical significance. The overall stone-free rate (97%) and complication rate (5%) were not significantly different between the two groups. The patient's anesthesia-related safety was not affected by the mode of ventilation as evidenced by no need to convert from LV to SV during the procedures. Conclusions: LV during RIRS has a significant positive impact on the overall improvement of surgical performance and effectiveness. It does not negatively affect the patient's anesthesia-related safety and may contribute to considerably improving the performance of in-training endourologists.
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Kourmpetis et al. (2018) conducted an RCT in Nephrolithiasis requiring retrograde intrarenal surgery (n=60). General anesthesia with low ventilation vs. General anesthesia with standard ventilation was evaluated on Fragmentation rate, removal rate, processing rate, and operating rate.
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