Haemodynamic, electrolyte and metabolic changes during percutaneous nephrolithotomy

Abstract

Objectives: The objectives were to evaluate haemodynamic, electrolyte and metabolic changes in patients undergoing percutaneous nephrolithotomy when normal saline was used for irrigation; and to correlate these changes with irrigation time, volume of irrigation fluid absorbed and number of percutaneous interventions.

Methods: Twenty adults undergoing percutaneous nephrolithotomy were studied. Heart rate, systolic and diastolic blood pressure, arterial blood gases, electrolytes and temperature were monitored before, during and after irrigation. Haemoglobin, urea and creatinine values were recorded before and 24 h after the procedure. Durations of anaesthesia and irrigation; volumes of irrigation fluid used and effluent fluid; and number of percutaneous interventions during the procedure were also recorded.

Results: No significant changes occurred in mean heart rate, systolic and diastolic blood pressure, electrolytes, haemoglobin, urea and creatinine. There was a significant fall in mean pH in postoperative period (P = 0.003) and bicarbonate values showed a negative correlation with duration of irrigation. Number of percutaneous interventions had positive correlations with duration of irrigation and volume of irrigant fluid absorbed.

Conclusions: No significant changes occurred in haemodynamics and electrolytes, but there was a trend towards metabolic acidosis. Arterial blood gases should be monitored during and after PCNL in cases with prolonged irrigation time, repeated percutaneous interventions and patients having compromised renal function and metabolic status.