Sedoanalgesia-based anesthesia approach in pediatric extracorporeal shock wave lithotripsy cases

BACKGROUND The aim of the study is to evaluate the safety, feasibility, and effectiveness of sedoanalgesia in pediatric patients undergoing extracorporeal shock wave lithotripsy (ESWL). METHODS This retrospective study included pediatric patients who underwent ESWL under a standardized sedoanalgesia protocol consisting of intravenous midazolam (0.0] mg/kg), fentanyl (1 mcg/kg), propofol (0.5–1 mg/kg), and ketamine (0.5–1 mg/kg) as needed. Any complications or adverse events related to sedoanalgesia were documented. RESULTS A total of 190 pediatric patients underwent 453 ESWL sessions. All procedures were completed successfully without conversion to general anesthesia. Spontaneous ventilation was preserved in all patients, and airway instrumentation was not required. Minor complications included transient desaturation (3.3]%) and nausea/vomiting (19.2%). No major anesthesia-related adverse events were observed. The mean stone size was 9 ± 2.86 mm for the kidney and 8 ± 2[14 mm for the ureter. The average number of sessions per patient was 2.4. CONCLUSION The fundamental principle of pediatric anesthesia is to use the lowest effective and shortest-acting anesthetic agents through careful titration. Our findings demonstrate that ESWL can be safely and effectively performed in children using a balanced sedoanalgesia protocol.