Anesthesia for Emergency Testicular Torsion Surgery
General anesthesia is the standard approach for emergency testicular torsion surgery, as it allows for optimal surgical conditions during scrotal exploration, detorsion, and bilateral orchidopexy.
Rationale for General Anesthesia
While the provided evidence does not explicitly detail anesthetic techniques, the nature of testicular torsion surgery necessitates general anesthesia for several critical reasons:
Surgical requirements: The procedure involves scrotal exploration, manual detorsion of the spermatic cord, assessment of testicular viability, and bilateral orchidopexy (fixation of both testes) to prevent recurrence 1, 2.
Patient population: Testicular torsion has a bimodal distribution with peaks in neonates and postpubertal boys, meaning many patients are pediatric or adolescent males who require general anesthesia for cooperation and comfort 1, 3.
Emergency nature: This is a surgical emergency requiring intervention within 6-8 hours of symptom onset to prevent permanent ischemic damage, and general anesthesia allows for rapid, definitive surgical management without delay 1, 3.
Surgical Procedure Under Anesthesia
The operation performed under general anesthesia includes:
Immediate surgical exploration with detorsion of the affected testis to restore blood flow 1.
Bilateral orchidopexy to fix both the affected and contralateral testis, as the contralateral testis was fixed in 57.6% of cases in systematic review data 2.
Assessment of testicular salvageability, with orchiectomy performed if the testis is non-viable (orchiectomy rate of 42% in boys undergoing surgery) 3.
Clinical Context
Time-critical intervention: The four- to eight-hour window before permanent ischemic damage occurs necessitates rapid anesthetic induction and surgical intervention 3, 4.
Patient presentation: Patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting, making general anesthesia both necessary for patient comfort and optimal surgical conditions 3.