General Anaesthesia and Ureteral Stent Placement: Risks and Alternative
Ureteral stent placement is a common procedure to manage kidney stones and other ureteral obstructions. The insertion of the stent is typically done in an operating room (OR) after putting a patient in a deep sleep-like state with the help of general anaesthesia. While general anaesthesia is very safe and makes invasive surgeries tolerable, it can cause side effects in some patients. The risk of complications is highest among elderly or obese patients or those with pre-existing medical conditions.
In this blog, we discuss common side effects associated with general anaesthesia and how ureteral stenting in an outpatient setting with local anaesthesia can help bypass these risks.
The Risks Associated With General Anaesthesia
General anaesthesia (GA) causes patients to lose consciousness, while local anaesthesia (LA) numbs a small, specific part of the body. Side effects or complications most commonly associated with general anaesthesia are:
Cardiovascular complications: Although very rare, general anaesthesia can cause serious heart-related side effects in some patients. The risk of negative outcomes such as heart attack, stroke, blood clots, or arrhythmia is higher among older adults and those with cardiovascular comorbidities.
Deep vein thrombosis: The use of muscle relaxants during anaesthesia can increase the size of leg veins or cause cracks in the vein lining, increasing the risk of deep vein thrombosis (DVT).
Sore throat: The use of an endotracheal tube to help the patient breathe while they’re unconscious can irritate the throat.
Hypothermia: Chills and fever are common side effects, occurring in up to half of the patients after regaining consciousness. In rare cases, the drugs used for general anaesthesia can cause malignant hyperthermia characterised by dangerously high fever, muscle contractions, and rapid heart rate.
Postoperative nausea and vomiting: Another common yet unpleasant side effect of general anaesthesia triggered by pain medications, motion, or type of surgery.
Postoperative delirium: In some patients, particularly the elderly, regaining consciousness after the procedure can cause confusion and disorientation for a few hours or days. However, in some cases, general anaesthesia can trigger postoperative cognitive dysfunction, leading to long-term memory problems. The risk of this complication is highest among older adults and those with pre-existing medical conditions such as congestive heart failure, Parkinson’s disease, or Alzheimer’s disease.
Benefits of Local Anaesthesia-Based Ureteral Stenting
Performing stent placements in an office setting with local anaesthesia can offer a number of benefits to the patients, doctors, and healthcare system:
Reduced Hospital Time
In comparison to local anaesthesia, general anaesthesia requires significant preparations and resources, often resulting in longer wait times. A study showed an approximate three-fold decrease in total time spent in hospital time when stent placement is done in a clinician’s office under local anaesthesia vs. in the OR with general anaesthesia.
2. Reduced Cost Burden
Multiple studies have demonstrated the role of local anaesthesia-based stent placement in lowering the cost burden on patients, hospitals, and the healthcare system. In one study, the difference in cost of stent placement under LA vs. GA was nearly fourfold ($7700 vs. $30,060). Another study reported hospital visit cost to be considerably lower if at the patient’s bedside with local anaesthesia vs. in an OR-based setting under GA ($11,000 vs. $25,000).
3. Reduced dependence on OR
In hospitals with high patient volumes, shifting a procedure as common as ureteral stenting to the office can free up OR for more critical surgeries. Office-based procedures with LA also reduce the need for hospital admissions while providing rapid pain relief to patients, minus the risks associated with general anaesthesia.
4. Rapid relief and recovery
For a condition as excruciatingly painful as kidney stone pain or acute renal colic, intervention should be as swift as possible. However, for GA-based stent placement, patients are required to wait for an OR slot, arrive several hours before the procedure, and recover from general anaesthesia afterwards. An office-based alternative with local anaesthesia not only provides a simpler, quicker, less invasive pathway to pain relief but also reduces the need for a bladder catheter, enabling patients to resume their normal lives sooner.
Akeeko Stent Inserter: Enabling a Local Anaesthesia-Based Alternative
Even though the incidence of side effects is higher under general anaesthesia, it remains part of the current standard of care for kidney stone pain, underscoring the need for a less invasive, local anaesthesia-based care pathway. Akeeko Stent Inserter (ASI) enables immediate ureteral stenting in an outpatient setting under local anaesthesia. This helps patients and hospitals save time, money, and resources while mitigating the risks linked to general anaesthesia.
References:
Safety and Efficacy of Ureteral Stent Placement at the Bedside Using Local Anesthesia - PubMed
