“Kidney stones - hydronephrosis - anesthesia ”
Are there contraindicators for using spinal conscious sedation in a patient undergoing surgical treatment for 8mm and 5mm kidney stones lodged just prior to bladder entrance - with hydronephrosis confirmed via CT? Patient is refusing general anesthesia sedation and is requesting spinal conscious sedation like she received in previous c-sections. Patient has high pain tolerance, had negative experiences with general anesthesia and is requesting to be numb but alert. Is there a valid reason to deny patient's request?
Female | 47 years old
2 Answers
Anesthesiologist
Spinal anesthesia is often possible and appropriate for manipulation of renal stones, but some issues should be considered and could make general anesthesia the preferred choice. Patients undergoing spinal anesthesia should not be receiving anticoagulants, have infection at the site of the block and must be able to breath comfortably when supine. The patient must also be cooperative for positioning and the procedure itself. Discharge to home is not common on the same day as a spinal anesthetic.
The answer to this question depends on several factors, including what methods the surgeon will use to remove or dissolve the stones, whether the surgeon will agree to a spinal anesthetic with sedation to do the procedure, and whether the anesthesiologist can administer a spinal anesthetic that will last for the entire procedure whose duration may be unpredictable. I suggest a conference between the three of you to discuss whether your desired anesthetic can or cannot be administered and the rationale involved (which may involve individual choices by the surgeon and anesthesiologist, as well as yourself.)
