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°C ± 0.32°C to 35.2°C ± 0.5°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.