Anesthetic Considerations

Suprapubic prostatectomy can be comfortably performed with the patient under a general or regional anesthetic. With respect to the latter, options include a continuous spinal or epidural anesthetic. Regional anesthesia is advantageous because it is an excellent skeletal and smooth muscle relaxation, airway-related complications (unexpected coughing, gagging, or bucking) can be mostly avoided, and postoperative hemostasis is enhanced in because the patient is more comfortable and tranquil patient (1). Potential disadvantages include a history of documented central or peripheral neurologic deficits after the use of regional anesthetic, potential bleeding tendencies associated with this method, documented chronic low back pain after receiving regional anesthetic, spinal stenosis and/or severe degenerative disk disease after regional anesthetic, and associated osseous metastasis (6). In addition, patient acceptance is low. Given the need for prolonged exaggerated lithotomy necessary to conduct simple perineal prostatectomy, most patients are best served by general endotracheal anesthesia with full muscle relaxation.

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