Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany.
Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany.
Urology. 2022 Jan;159:182-190. doi: 10.1016/j.urology.2021.04.078. Epub 2021 Jul 31.
To compare perioperative management and functional outcome of spinal anesthesia (SpA) to general anesthesia (GA) in high-risk patients treated for lower urinary tract symptoms with Holmium laser enucleation of the prostate (HoLEP).
In the current retrospective analysis, a propensity-score-matching of patients treated for lower urinary tract symptom with HoLEP (n = 300) in SpA with ASA>2 (n = 100), GA with ASA>2 (GA-high-risk) (n = 100) or GA with ASA≤2 (GA-low-risk) (n = 100) was performed. The impact of anesthesiologic mode on perioperative anesthesiologic outcome, early functional outcome and treatment related adverse events (according to Clavien Dindo), was evaluated.
Hypotensive episodes were significantly less frequent in the SpA-cohort (9%) compared to the GA-high-risk cohort (32%) and the GA low-risk cohort (22%) (each P <.05 respectively). SpA-patients showed a significantly shorter median time in post anesthesia care unit (PACU-time: 135 minutes; 120-166.5) compared to GA-high-risk patients (186 minutes; 154-189.5), with significant less referrals to Intermediate care unit (1% vs 9 %); (each P <.05). PACU-time (99 minutes) and Intermediate care unit referrals (0%) for GA-low-risk were lower than for both other cohorts. Postoperative requirement for analgesics was significantly lower in the SpA-cohort (2%), compared to both GA-cohorts (74% and 61% respectively; P <.05). No significant difference was found regarding early functional outcome or treatment related adverse events (p-range: 0.201-1.000).
For patients undergoing HoLEP, SpA provides greater hemodynamic stability and allows faster overall postoperative recovery with preferable pain management. Yielding a comparable functional outcome, it is a safe and efficient alternative to GA in high-risk patients.
比较高危前列腺增生患者行钬激光前列腺剜除术（HoLEP）时全身麻醉（GA）与椎管内麻醉（SpA）的围手术期管理和功能结局。
本回顾性分析中，对 SpA 组（ASA>2，n=100）、GA 高风险组（ASA>2，n=100）和 GA 低风险组（ASA≤2，n=100）行 HoLEP 治疗的下尿路症状患者进行倾向评分匹配。评估麻醉方式对围手术期麻醉结局、早期功能结局和治疗相关不良事件（根据 Clavien Dindo 分类）的影响。
SpA 组低血压发作（9%）明显少于 GA 高风险组（32%）和 GA 低风险组（22%）（均 P<.05）。SpA 组患者术后在麻醉后监护病房（PACU）的中位时间（PACU 时间：135 分钟；120-166.5）明显短于 GA 高风险组（186 分钟；154-189.5），转至中级护理病房的比例显著较低（1% vs 9%）（均 P<.05）。GA 低风险组的 PACU 时间（99 分钟）和转至中级护理病房的比例（0%）均低于其他两组。SpA 组术后需要镇痛药物的比例（2%）明显低于 GA 两组（分别为 74%和 61%；P<.05）。早期功能结局或治疗相关不良事件无显著差异（p 范围：0.201-1.000）。
对于行 HoLEP 的患者，SpA 可提供更好的血流动力学稳定性，促进术后整体快速恢复，并且疼痛管理效果更佳。SpA 在高危患者中是一种安全有效的 GA 替代方案，可获得相似的功能结局。
