Heart Health Articles

Comparison Of Two Ventilation Techniques During General Anesthesia For Extracorporeal Shock Wave Lithotripsy

July 19, 2017

UroToday- Almost 20 years ago I was introduced to this form of anesthesia by the late Dr. Birdwell Finlayson. In essence the high-frequency jet ventilation (HFJV) results in minimal movement of the kidney while still permitting proper ventilation of the patient. In this retrospective study, the authors used a "Ben Jet" (Baldwin Medical, Knoxfield, Victoria, Australia) at a rate of 150-250 breaths per minute. In earlier studies, as in this one, the use of HFJV resulted in delivery of fewer shock waves in order to achieve the same degree of stone fragmentation. Unfortunately, the authors did not report the overall procedural time but the need for 1000 less shock waves (i.e. 1/3rd reduction) should have translated into a briefer procedure. In theory, fewer shock waves should also result in less perinephric and renal trauma however; no post treatment CT scans were obtained. There was no difference in the need for post treatment admission (5-7%). While this article is of interest for all of us dealing with urolithiasis and SWL it also may have some bearing on the segment of the urological community which is becoming more interested in image guided needle ablation of renal masses. The ability of HFJV to largely eliminate renal movement should enhance one's ability to accurately position a cryoablation or radiofrequency treatment needle in a 1 - 3 cm. renal mass. We'll see …

Cormack JR, Hui R, Olive D, and Said S

Urol. 70(1):7-10, July 2007
doi:10.1016/j.urology.2007.03.045

Reported by UroToday Contributing Editor Ralph V. Clayman, M.D

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