Anesthetic considerations during percutaneous nephrolithotomy

Abstract

Study objective: To assess anesthesia-related complications during and following percutaneous nephrolithotomy (PCNL) for staghorn stones.

Design: Prospective study and a detailed case report.

Setting: Medical center in southern Israel.

Patients: 20 consecutive patients undergoing PCNL for staghorn stones.

Interventions: All patients underwent PCNL during general anesthesia.

Measurements: Duration of surgery, esophageal temperature, hemoglobin (Hb) concentration, and requirements for blood transfusion, mean volume of irrigation fluid, and serum sodium and potassium concentration were recorded.

Main results: Mean age was 50.7 +/- 14.9 y (range, 26-76 y). Mean duration of the procedure was 120.0 +/- 42.5 min (range, 75-240 min). Mean volume of irrigation fluid was 34.1 +/- 15.3 L (range, 18-80 L). There was a significant decrease in Hb concentration from 13.7 +/- 1.71 to 12.2 +/- 1.4 g/dL, but no patient required blood transfusion. There was a statistically significant reduction in esophageal temperature from 36.4 degrees C +/- 0.32 degrees C to 35.2 degrees C +/- 0.5 degrees C. There were no significant changes in sodium or potassium concentration before or after PCNL.

Conclusions: Anesthesia during PCNL for staghorn stones is a challenge because of the possibility of fluid absorption, dilutional anemia, hypothermia, or significant blood loss.