❌ That Moment is to be Revised 🔴 Control your movement during Spinal Anesthesia 🔴 LASER SHOULD TARGET STONE ONLY 🔴 Expect the Unexpected PETRA PEARLS

@PETRAurogroup @PEARLSendouro Coordination of movement with respiration is the 🔑

@PETRAurogroup @PEARLSendouro 🔹Use General Anesthesia 🔹No Endotracheal Intubation in most cases 🔹Supra glottic devices does the job 🔹EtCO2 monitoring is must 🔹Avoid Spinal anesthesia as far as possible

@PETRAurogroup @PEARLSendouro Real nightmare, tranexamic acid helps. Wish patient be well.

@PETRAurogroup @PEARLSendouro This video should be shown to anaesthesia staff who still insisting to put RIRS patients sleep under spinal anaesthesia... Really hard for urologist to operate without putting pts to sleep with GA with possibility higher risks like this.

@PETRAurogroup @PEARLSendouro Thank you for sharing the video. Is there any way you could do to stop the bleeding endoscopically, sir?

@PETRAurogroup @PEARLSendouro Ty for sharing. Hope everything turned out ok.

@PETRAurogroup @PEARLSendouro Bleeding usually stops spontaneously

@PETRAurogroup @PEARLSendouro Do always intermittent lasing ....getting into rhythm of respiration is important:: my majority of cases under spinal anaesthesia...."" go slow /low ( less frequency and less Energy)."""

@PETRAurogroup @PEARLSendouro 🟢 General anesthesia is better for RIRS 🟢 Controlled ventilation either by reducing the tidal volume between 200-250. This gives slow respiratory movements 🟢 For large volume stones anaesthesiologist to give manual ventilation. Can stop for few minutes observing the ETC02

@PETRAurogroup @PEARLSendouro A real nightmare, what was the management you did at that moment??