Abstract

Background: Retrograde intrarenal surgery (RIRS) is a well-established minimally invasive technique for the management of renal stones. However, intraoperative physiological and anesthetic events during the procedure remain poorly characterized, particularly in the context of newer technologies such as suction-assisted systems. Objective: The objective of this study is to evaluate the occurrence of intraoperative anesthetic and physiological adverse events during suction-assisted RIRS and to assess its safety profile. Methods: We conducted a prospective, single-center observational sub-analysis of the “Trifecta factors in ureteroscopy” project. A consecutive cohort of 30 patients undergoing RIRS with suction ureteral access sheaths (sUAS) between August 2025 and January 2026 was analyzed. Baseline demographics, stone characteristics, and intraoperative anesthetic parameters—including airway pressure, Bispectral Index (BIS), and hemodynamic events—were prospectively recorded. Primary endpoints included intraoperative fever, sustained tachycardia, blood pressure alterations, and anesthetic complications. Results: The cohort had a mean age of 56.4 years with an equal gender distribution. Mean stone size was 12.9 mm, and mean operative time was 50.3 min. Intraoperative monitoring demonstrated stable anesthetic conditions, with a mean airway pressure of 16.3 cmH2O and a mean BIS of 42.6. No major anesthetic complications or significant blood pressure fluctuations were observed. Minor intraoperative events included fever in 10% of cases and sustained tachycardia in 6.7%. No cases of intraoperative anesthetic instability were recorded. Conclusions: Within this descriptive cohort, suction-assisted RIRS under general anesthesia demonstrated a favorable safety profile with stable intraoperative parameters, though larger comparative studies are required to confirm these preliminary findings.

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