Sedation and Analgesia Using PFK Versus General Anesthesia in Urological Procedures
Sedation and Analgesia Using PFK Versus General Anesthesia in Urological Procedures
Anesthesia in urological surgeries might constitute a great challenge to anesthesiologists.
 Especially that a great proportion of these patients are elderly with a lot of comorbidities.
 This put these patients at the risk of developing medical adverse events after being
 anesthetized by general anesthesia. The aim of this study is to compare between intravenous
 sedation with analgesia versus general anesthesia in patients undergoing urological surgical
 procedures.
Anesthesia in urological surgeries might constitute a great challenge to anesthesiologists.
 Especially that a great proportion of these patients are elderly with a lot of comorbidities.
 This put these patients at the risk of developing medical adverse events after being
 anesthetized by general anesthesia. The aim of this study is to compare between intravenous
 sedation with analgesia versus general anesthesia in patients undergoing urological surgical
 procedures.

 The first group which underwent general anesthesia, was anesthetized using Fentanyl (2 mcg
 per kg) and Propofol (1-2 mg per kg). Laryngeal mask airway was then inserted.

 The second group underwent intravenous sedation and analgesia by using a mixture of Fentanyl,
 Propofol and Ketamine (PFK mixture). The mixture consists of 100 mcg Fentanyl, 100 mg
 Propofol, 100 mg of Ketamine. In addition, 40 mg of Lidocaine were added, this aimed to
 reduce the pain on injection caused by Propofol. Moreover, 4 ml of water of injection were
 added to the mixture. This resulted in a mixture of 5 mcg/ml of Fentanyl, 5 mg/ml of
 Propofol, and 5 mg/ml of Ketamine. By this, each ml of the mixture contained 10 mg (ketamine
 and propofol) + 5 mcg fentanyl. Each patient received an initial dose of 0.5 mg/kg from the
 solution, then after waiting for 60 seconds, another 0.5 mg/kg were given. Maintenance was
 given as boluses of 0.2- 0.33 mg/kg every three to five minutes. No laryngeal mask airway nor
 endotracheal tube were inserted, and the patients were breathing spontaneously through a
 simple face mask on support of 3 L/min O2.
Inclusion Criteria:

 -  patients above the age of 30 years

 -  patients who were admitted for minor urological surgeries under the care of urology
 team. Minor urological procedures, included cystoscopy, trans-urethral resection of
 tumor (TURT), uretroscopy, double J insertion, and double J removal.

 Exclusion Criteria:

 -  patient refusal.

 -  urgent and emergency cases, which were not elective procedures.

 -  Surgeries that were expected to take a long duration (more than 1.5 hour).