Clot Evacuation

Anesthesia Implications

Position: Supine, arms at side on armboards
Time: 30-60 min (short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: High (7-10)
Maintenance Paralytic: Ask surgeon

Anesthetic Approaches

  • GLMA
  • GETT

High post-operative pain (general considerations): Plan ahead to treat pain in the postoperative period. If not contraindicated, consider hydromorphone or other long-acting analgesics along with adjuncts such as Ofirmev and/or toradol. Where possible, give during the operative period to limit pain in the postoperative period. Where applicable, consider peripheral nerve blocks and/or epidural interventions.

The Pathophysiology

Any form of bleeding in the urinary tract can cause a clot to form. This clot can occlude the normal flow of urine and subsequently results in bladder distention and extreme discomfort to the patient. This is often caused by radiation therapy for cancer.

The Surgery

A clot has formed somewhere in the urinary tract and needs to be removed to resume the normal flow of urine. The procedure will include a cystoscopy to locate the clot and vessels that are bleeding. Fulguration will be utilized to stop the bleeding vessels and suction is employed to pull the clot out of the urinary tract.