Management of bladder function after outpatient surgery.
| Autor: | Pavlin DJ; Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195, USA. jpavlin@u.washington.edu, Pavlin EG, Fitzgibbon DR, Koerschgen ME, Plitt TM |
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| Jazyk: | angličtina |
| Zdroj: | Anesthesiology [Anesthesiology] 1999 Jul; Vol. 91 (1), pp. 42-50. |
| DOI: | 10.1097/00000542-199907000-00010 |
| Abstrakt: | Background: This study was designed to test a treatment algorithm for management of bladder function after outpatient general or local anesthesia. Methods: Three hundred twenty-four outpatients, stratified into risk categories for urinary retention, were studied. Patients in category 1 were low-risk patients (n = 227) having non-pelvic surgery and randomly assigned to receive 10 ml/kg or 2 ml/kg of intravenous fluid intraoperatively. They were discharged when otherwise ready, without being required to void. Patients in category 2 (n = 40), also presumed to be low risk, had gynecologic surgery. High-risk patients included 31 patients having hernia or anal surgery (category 3), and 31 patients with a history of retention (category 4). Bladder volumes were monitored by ultrasound in those in categories 2-4, and patients were required to void (or be catheterized) before discharge. The incidence of retention and urinary tract symptoms after surgery were determined for all categories. Result: Urinary retention affected 0.5% of category 1 patients and none of category 2 patients. Median time to void after discharge was 75 min (interquartile range 120) in category 1 patients (n = 27) discharged without voiding. Fluids administered did not alter incidence of retention or time to void. Retention occurred in 5% of high-risk patients before discharge and recurred in 25% after discharge. Conclusion: In reliable patients at low risk for retention, voiding before discharge appears unnecessary. In high-risk patients, continued observation until the bladder is emptied is indicated to avoid prolonged overdistention of the bladder. |
| Databáze: | MEDLINE |
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