In the realm of urologic procedures, a noteworthy shift is taking place, and it’s all about conscious sedation. Canadian researchers have delved into the realm of conscious sedation as an attractive alternative to general anesthesia, and the results are remarkable.

Patient preference for Conscious Sedation:

Patients undergoing various urologic procedures, including endourologic, ureteric, urethral, and advanced cystoscopic interventions, have made their voices heard. A majority of these patients expressed a distinct preference for conscious sedation, even when given the choice to be fully awake during the procedure. Kapilan Panchendrabose, MSc, a medical student from the University of Manitoba in Winnipeg, Manitoba, Canada, presented these findings at the European Association of Urology (EAU) 2022 Annual Meeting.

Traditionally, the standard approach for most urologic procedures has been to administer general or spinal anesthesia to patients. However, this approach comes with its fair share of risks, including adverse side effects, increased costs, and longer operating room wait times. Conscious sedation, offering anesthetic and analgesic relief during certain urologic procedures, provides a promising solution.

Expanding the Technique by Studying Details

The University of Manitoba researchers initially explored conscious sedation for the treatment of ureteric calculi and expanded this technique to include various advanced urologic procedures. Their hypothesis was straightforward: patients under conscious sedation would not only tolerate the procedure but would also prefer it to general anesthesia for subsequent surgeries.

Their prospective, nonrandomized cohort study, conducted from June through August 2021, included rigid and flexible ureteroscopy, ureteric stent insertions/exchanges, scrotal/penile procedures (such as hydroceles and testicular biopsies), urethral dilations, and advanced cystoscopic procedures (including bladder biopsies and botox therapy). These procedures were performed with sedation using fentanyl, midazolam, or both agents.

The study outcomes were highly promising. With a success rate of 96.5% and no intraoperative complications, conscious sedation emerged as a safe and effective choice for urologic procedures. Even more compelling, 85% of patients, out of the 161 who completed post-procedure questionnaires four to six weeks later, expressed a strong preference for conscious sedation if they were to undergo a similar procedure in the future.

Factors influencing the choice of conscious sedation

When it comes to the factors influencing the choice of conscious sedation over general anesthesia, age played a role, with older patients showing a greater preference. Additionally, the surgeon’s perception of the patient’s tolerability during the procedure had an impact.

In a multivariate analysis, other variables such as body mass index, gender, prior conscious sedation experience, Charlson comorbidity index, procedure type, drug type, and time of the procedure did not predict the choice of anesthesia.

Kapilan Panchendrabose emphasized that IV conscious sedation is a practical alternative for the majority of advanced urologic procedures. However, careful patient selection is key to ensure a smooth and successful procedure.

While conscious sedation has gained prominence in urologic procedures, some urologists opt for a different approach. They prefer utilizing local anesthesia in combination with nitrous oxide to help patients relax during the procedure. This approach ensures safety and a stress-free experience for patients.

Why conscious sedation for urologic procedures is preferred

In conclusion, the study’s findings underscore the growing importance of conscious sedation as a preferred and safer alternative for urologic procedures. Patient comfort and safety are paramount, and the choice of anesthesia should be tailored to individual preferences and the specific nature of the procedure.