2008 Annual Meeting Abstracts
High-Frequency Jet Ventilation versus Conventional Anesthetic Techniques during Extracorporeal Shock Wave Lithotripsy: Is There a Benefit When Utilizing a Newer Unit with Smaller Blast Paths?
Wesley A Mayer, Phillip Mucksavage, Jeff E. Mandel*, Keith N Van Arsdalen
University of Pennsylvania Health System, Philadelphia, PA
Introduction:
The benefit of high-frequency jet ventilation (HFJV) during extracorporeal shock wave lithotripsy (ESWL) has been reported. However, these studies employed older lithotripsy units with larger blast paths when compared to newer machines. We investigated how HFJV affects the clinical parameters of ESWL utilizing a newer lithotripsy unit with a smaller focused blast path.
Methods:
We retrospectively reviewed all patients who underwent ESWL by a single surgeon from July 2006 until December 2007 with the Seimens LITHOSTAR Modularis. Either HFJV or conventional anesthetic techniques were utilized based on the anesthesiologists’ preference. Preoperative imaging was reviewed for stone size, number, and location. Total OR time, procedure time, number of shocks and total energy delivery were analyzed. Postoperative imaging was review for stone-free rates.
Results:
A total of 112 patients underwent ESWL with 80 undergoing conventional anesthesia, and 32 with HFJV. Age, BMI, preoperative stone size, number, and location were not significantly different between the groups. The HFJV group required significantly less total shocks (3358 vs. 3754, p=0.0015) and total energy (115.8 joules vs. 137.2 joules, p=0.0015). Total operating room time, ESWL procedure time, and postoperative stone-free rates were not significantly different.
Conclusions:
Previous studies utilizing older ESWL units with larger blast paths have shown that HFJV can be effective in reducing total shocks and total energy. Reduced shocks and energy may be beneficial in terms of decreased postoperative pain and nausea. Our data is consistent with these studies but demonstrates benefit with new units that have smaller blast paths.
