• Rezūm is a short, minimally invasive procedure for BPH that avoids major risks of TURP (fluid overload, TUR syndrome, bleeding).
• In elderly, anticoagulated patients with AF and comorbidities, neuraxial anesthesia may be contraindicated; short general anesthesia with spontaneous ventilation is a safe alternative.
• Careful titration of propofol and sevoflurane with adjuncts (fentanyl, dexmedetomidine, glycopyrrolate) minimizes hemodynamic swings and movement.
• Lithotomy positioning, risk of patient movement, and the surgical learning curve demand vigilance from the anesthesia team.
• Anticoagulation resumption and catheter care remain essential parts of postoperative planning.

References

1. McVary KT, Roehrborn CG, et al. Rezūm water vapor thermal therapy for lower urinary tract symptoms secondary to BPH: 2-year results. J Urol. 2019;202(3):601-609.
2. Gilling PJ, Barber N, Bidair M, Anderson P, Sutton M, Roehrborn C. Rezūm water vapor thermal therapy: 4-year results and safety profile. Urology. 2021;147:154-161.

Patient: An 89-year-old male with recurrent UTIs and indwelling catheter due to obstructive BPH was scheduled for Rezūm therapy.

Comorbidities:

• Chronic atrial fibrillation on apixaban 5 mg, stopped 48 h prior.
• Recovered from left frontoparietal acute infarct.
• Hypertension on nebivolol 2.5 mg BD, sacubitril-valsartan 50 mg OD, rosuvastatin 10 mg HS.
• ECHO: Bilateral atrial enlargement, EF 55%, pulmonary artery pressure 44 mmHg.
• Renal function: Creatinine 1.6 mg/dL.
• Vitals: HR 88/min (irregular), BP 140/90 mmHg.

References

3. Yates J, Barham CP, Perry M. Perioperative risk assessment in the elderly patient. Anaesthesia. 2020;75(S1):e83-e92.

4. Weitz JI, Pollack CV. Practical management of anticoagulation in patients with atrial fibrillation. Circulation. 2017;135(7):648-651.

• High-risk profile due to advanced age, anticoagulation, AF with pulmonary hypertension, and prior stroke.
• Spinal anesthesia avoided because apixaban was stopped only 48 h earlier and renal clearance was impaired.
• Planned for short GA with spontaneous breathing to maintain safety, hemodynamic stability, and airway control.

References

5. Narouze SN, Benzon HT, Provenzano DA, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (ASRA guidelines). Reg Anesth Pain Med. 2018;43(3):225–262.

6. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation. Eur Heart J. 2016;37(38):2893-2962.

• Premedication/Induction:
• Fentanyl 100 mcg IV
• Glycopyrrolate 0.2 mg IV
• Dexmedetomidine 25 mcg IV over 15 min
• Propofol 40 mg IV
• Airway: Mask ventilation with oxygen and air.
• Maintenance: Sevoflurane in oxygen-air mixture, spontaneous breathing.
• Duration: 10 minutes.
• Course: Hemodynamically stable, no adverse airway or cardiovascular events.

References

7. Weerink MAS, Struys MMRF, Hannivoort LN, et al. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;56(8):893–913.

8. Miller RD, Eriksson LI, Fleisher LA,...