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PHYSION® PROTOCOLS CE-DAS® UROGENICS® LOCAL ANAESTHESIA (EMDA/LA) OF THE BLADDER WALL

DRUG SOLUTION

NAROPINE 7.5 mg/ml WITH EPINEPHRINE 1/100,000: 120 ml Epinephrine 1/100,000 1.5 mg: 1.5 ml Distilled water: 30 ml

CATHETER-ELECTRODE

: CE-DAS® UROGENICS®/Ag 9701

CURRENT

: 25 mA

TIME OF TREATMENT

: 20 minutes

POLARITY

: POSITIVE (+)

TYPE OF CURRENT

: pulse

RISE-RATE

: 50-60 mA/sec

PROCEDURE: 1.

Anxiolysis: desireable in some patients. • a benzodiazepine the night before surgery • midazolam 3 mg im 1-2 hours before procedure or • midazolam 1-2 mg iv 5 minutes before procedure.

2.

Have the patient lie comfortably supine: Do not place in lithotomy position.

3.

Prepare a sterile bowl containing the 150 ml drug solution.

4.

Test the catheter-balloon twice at 5 ml with air before catheterisation, following the instructions for use of the CE-DAS® UROGENICS®.

5.

Catheterise the patient with CE-DAS® UROGENICS® catheter, using conventional gellubricants (preferably lidocaine based, water soluble) and inflate balloon at 3 ml with air.

6.

Drain the bladder.

November 2004


7.

Rapidly rinse the bladder once or twice with water to remove residuals and check that there is no bleeding.

8.

Infuse 150 ml drug solution into the bladder.

9.

Follow the instructions of the PHYSIONIZER速 and set all values as indicated above.

10.

Select a large area of unblemished skin on the abdomen and thoroughly "degrease" by wiping with alcohol.

11.

Wet the 2 white dispersive electrodes with saline solution 0.9% or tap water, then cover the abdomen with a layer of 5-7 mm thick conductive gel and place the electrodes. Assure complete contact without air bubbles, by pressing and sliding side to side the 2 dispersive electrodes.

12.

Connect the red wire of the PHYSIONIZER速 to the catheter CE-DAS速 UROGENICS速 and the black wire to the dispersive electrodes.

13.

Push "start" to run the treatment.

14.

At the end of EMDA the current will gently ramp down automatically and the machine will beep.

16.

Retain the drug solution in the bladder until the patient has entered the OR, then drain the solution, deflate the catheter-balloon and remove the catheter. Duration time of local anaesthesia from the end of the EMDA treatment : 100-120 minutes

PROCEDURES SUITABLE FOR EMDA/LA - Biopsies. - TURB. - Incisions of the bladder neck (BNI). ABSOLUTE CONTRAINDICATIONS TO EMDA/LA - Allergy/Idiosyncrasy to local anesthetic drugs (dental history). - Massive intravesical bleeding denoting rupture of a large vein. - Pregnancy - Patients taking medication classified as monoamine oxidase inhibitors. RELATIVE CONTRAINDICATIONS - Strictures of the urethra or bladder neck. - Overt psychosis (1-2% patients). - Alcoholism (~1 % patients). - Active (generalized inflammatory) infection of the lower genito-urinary tract.

November 2004

Endoscopic Urology  

Endoscopic Urology

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