Anesthesia for Urological Surgery

Radical orchiectomy

Radical orchiectomy can be done with spinal anesthesia. Minimally L1 dermatome needs to be achieved for adequate anesthesia. 

Bupivicaine 0.75% with dextrose 1.5-2cc (10-15mg)


TURP

Spinal anesthesia is the preference.
T10 - T6-7 Dematome will be needed.

Before proceeding with spinal, clear patient of valvular heart disease or coagulopathy

Hyperbaric 

Bupivicaine 0.75% with dextrose 1.5cc (10-15mg)

Isobaric

Bupivicaine 0.5% - 15mg
Tetracaine 0.5% with saline or CSF - 15mg (3cc)

25mcg of fentanyl or morphine 0.2mg can be added

Atropine 0.5mg for bradycardia

Minimal amount of NS can be given due to circulatory overload.

20cc/minute of irrigation solution can be absorbed during TURP up to 200cc/min.

Prepare pressors

Treatment of TURP symdrome
- Lasix 20mg
- ABG, check for serum Na+
- Midazolam for seizures
- Hypertonic saline for hyponatremia

Radical Prostatectomy

Can be done with epidural

 1-2 cc of local anesthetic per segment of dermatome