Anesthesia In Percutaneous Nephrolithotomy Research Articles

Comparative analysis of combined spinal–epidural anesthesia and general anesthesia in percutaneous nephrolithotomy: a prospective study on surgical team and operating room personnel satisfaction

ObjectiveWe aimed to investigate the efficacy and complications of combined spinalepidural anesthesia and general anesthesia in percutaneous stone surgery prospectively.Materials and methodsThe study prospectively included patients who underwent percutaneous nephrolithotomy with general anesthesia (Group.1) or combined spinal–epidural anesthesia (Group.2) at the Department of Urology, Training and Research Hospital, Karabuk University. between December 2018 and December 2019. The effect of the anesthesia technique on the comfort and satisfaction of the operating room personnel, surgeon and anesthesia team were prospectively evaluated and recorded.ResultsDuring the postoperative period, the spinal anesthesia group had a significantly lower visual analog score than the general anesthesia group. No patient in either group required narcotic analgesics during the postoperative period. In terms of overall satisfaction scores, the surgeon performing the surgical procedure had a significantly higher satisfaction score in the general anesthesia group than in the CSEA group. The score was considered good in the general anesthesia group and moderate in the CSEA group. Personnel satisfaction was higher in the patient group that underwent CSEA. In the general anesthesia group, the score was considered to be average. In the CSEA group, the satisfaction score was considered good, with a statistically significant difference (p < 0.05). The anesthesia team’s satisfaction score was moderate, with no significant difference between the CSEA and general anesthesia groups (p > 0.05).ConclusionPCNL under CSEA can be performed safely in certain individuals. Different anesthetic techniques may have varied levels of satisfaction among the surgical team.

Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis.

The aim of this study is to perform a high-quality meta-analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population-adult patients who underwent PCNL; Intervention-postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control-single dose of antibiotic during the induction of anesthesia; and Outcome-systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random-effects model was employed, and the alpha risk was defined as < 0.05. Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 - 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 - 5.316, p=0.140). Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.

Safety and efficacy of general anesthesia versus spinal anesthesia in percutaneous nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized &gt;20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. Aims and Objectives: The objective of this study was to assess and compare the efficacy and safety of spinal anesthesia (SA) versus general anesthesia (GA) in PCNL. Materials and Methods: A prospective randomized study included eighty-two patients who were enrolled to receive either SA or GA for PCNL. The study assessed patients’ characteristics, vital parameters, requirements for additional analgesia, and patient satisfaction. In addition, intraoperative and post-operative complications were documented. Patients’ satisfaction was also analyzed. Results: In both groups, the vital parameters were consistently maintained at safe levels during the procedures. Patients in the SA group exhibited a lower analgesia consumption on the 1st post-operative day compared to the GA group (P&lt;0.05). Post-operative hypotension was higher in the SA group than in the GA group (17% vs. 7%). Patients in the GA group reported higher patient satisfaction scores than the SA group (mean 4.39+0.59 vs. 3.81+0.64). Conclusion: Both SA and GA are safe and effective in PCNL. SA is associated with fewer complications and reduced postoperative analgesia consumption. However, GA tends to offer higher satisfaction levels for patients. Each method of anesthesia has its own advantages and disadvantages. The final choice between general and SA should be based on the patient’s condition and surgical team preference.

General versus spinal anesthesia in percutaneous nephrolithotomy: A systematic review and meta-analysis.

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized >20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. This study aimed to compare the efficacy and safety between general and spinal anesthesia for PCNL. Methods: A systematic review and meta-analysis study. A systematic, electronic literature search was performed in several databases, including PubMed, Scopus, and Google Scholar until July 1 st, 2022. The quality of the articles was examined using Crombie's Items (for non-randomized controlled trials(RCTs)) and Jadad Scale (for RCTs). The outcomes assessed were operation time, fluoroscopy time, length of stay, stone-free rate, overall complication rate, specific postoperative complications, cost, pain score, and postoperative analgesic requirement. The article selection was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We assessed four RCTs and eight retrospective studies. Meta-analysis of selected studies was performed using the Review Manager 5.3. Results: General anesthesia resulted in fewer Clavien-Dindo grade II (OR: 0.68; 95% CI: 0.49 - 0.94; p=0.02), major complications (OR: 0.65; 95% CI: 0.45 - 0.94; p=0.02, and lower transfusion rates (OR: 0.70; 95% CI: 0.53 - 0.94; p=0.02). Whereas spinal anesthesia resulted in faster operation time (Mean Difference: -12.98; 95% CI: -20.56 - -5.41; p<0.001, fluoroscopy time (MD: -26.15; 95% CI: -42.79 - -9.50; p=0.002), reduced length of stay (MD: -0.47; 95% CI: -0.75 - 0.20; p<0.001), and lower postoperative analgesic requirement and cost. No significant difference in stone-free rate (OR: 1.08; 95% CI: 0.92 - 1.26; p=0.37). PCNL performed using either general anesthesia or spinal anesthesia is equally safe and effective. Conclusions: Each method of anesthesia has its own advantages and disadvantages. The final choice between general and spinal anesthesia should be based on the patient's condition and surgical team preference.

General versus spinal anesthesia in percutaneous nephrolithotomy: A systematic review and meta-analysis

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized &gt;20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. This study aimed to compare the efficacy and safety between general and spinal anesthesia for PCNL. Methods: A systematic review and meta-analysis study. A systematic, electronic literature search was performed in several databases, including PubMed, Scopus, and Google Scholar until July 1st, 2022. The quality of the articles was examined using Crombie's Items (for non-randomized controlled trials (RCTs)) and Jadad Scale (for RCTs). The outcomes assessed were operation time, fluoroscopy time, length of stay, stone-free rate, overall complication rate, specific postoperative complications, cost, pain score, and postoperative analgesic requirement. The article selection was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We assessed four RCTs and eight retrospective studies. Meta-analysis of selected studies was performed using the Review Manager 5.3. Results: General anesthesia resulted in fewer Clavien–Dindo grade II (OR: 0.68; 95% CI: 0.49 – 0.94; p=0.02), major complications (OR: 0.65; 95% CI: 0.45 – 0.94; p=0.02, and lower transfusion rates (OR: 0.70; 95% CI: 0.53 – 0.94; p=0.02). Whereas spinal anesthesia resulted in faster operation time (Mean Difference: -12.98; 95% CI: -20.56 – -5.41; p&lt;0.001, fluoroscopy time (MD: -26.15; 95% CI: -42.79 – -9.50; p=0.002), reduced length of stay (MD: -0.47; 95% CI: -0.75 – 0.20; p&lt;0.001), and lower postoperative analgesic requirement and cost. No significant difference in stone-free rate (OR: 1.08; 95% CI: 0.92 – 1.26; p=0.37). PCNL performed using either general anesthesia or spinal anesthesia is equally safe and effective. Conclusions: Each method of anesthesia has its own advantages and disadvantages. The final choice between general and spinal anesthesia should be based on the patient's condition and surgical team preference.

Spinal anesthesia versus general anesthesia for percutaneous nephrolithotomy surgeries - a prospective study

Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgery for extracting renal and urinary stones, and a choice modality in large, multiple, and stag-horn stones. Anaesthesia for PCNL can be general or regional. Despite good results of PNCL with general anaesthesia, it may cause atelectasis, drug reactions, nausea, and vomiting. General anaesthesia (GA) has its limitations in the form of poor postoperative pain control, greater incidence of nausea and vomiting, prolonged recovery stays and prolonged hospitalizations.Methods: The study was performed in a tertiary care centre. A prospective, randomised study including 60 patients divided into 2 groups. Data collection tools included study proforma, numerical rating scale (NRS) scores and visual analog scale (VAS) scores. Data analysed using science and statistical packaged (SPSS) version 21, independent t tests and z-test for proportion.Results: The demographic data when statistically analysed showed no statistically significant differences between the groups. Haemoglobin percentage (Hb%) was significantly lower in GA group. Spinal anaesthesia (SA) group showed lower VAS and NRS scores hence lower requirement of pain relief and antiemetics. The post-operative complications were insignificant.Conclusions: We concluded that SA is safe and effective method as an alternative method for PCNL surgeries.

DOES SEVERE OBESITY EFFECT EARLY POSTOPERATIVE RECOVERY AND SURGICAL OUTCOMES IN PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY UNDER SPINAL ANESTHESIA?

Objective: The primary aim of this study is to evaluate if severe obesity has any deleterious effect on the early postoperative course in patients undergoing percutaneous nephrolithotomy (PNL) under spinal anesthesia, and the secondary aim is to determine whether severe obesity changes surgical results. Material and Method: The study included 100 patients who underwent a PNL operation for kidney stones of ≥2cm in our clinic. Accordingly, those with BMI &lt;35 kg/m2 formed the first while the severely obese BMI ≥35 kg/m2 formed the second group. Age, gender, stone burden, pre/postoperative hemoglobin levels, number and regions of access, duration of surgery, perioperative complications and Visual Analogue Scale score at 24h, PACU admission/ discharge Aldrete scores, and PACU length of stay were recorded. Results: The VAS score was 5.0±1.3 in group 1 while it was 5.3±1.8 in group 2 (p=0.32). The length of the hospital stay was 3.3±1.3 days in patients with BMI &lt;35 kg/m2 and 3.0±1.0 in patients with BMI ≥35 kg/m2 (p=0.36). A 98% stone-free rate was found in the severely obese group and 96% in the normal BMI group, and there was no significant difference between the groups (p=0.672). There was a statistically significant difference in terms of PACU discharge Aldrete scores between groups (9.9±0.3 vs. 9.6±0.4 in groups 1 and 2, respectively) (p=0.03). Finally, the time interval in PACU was 39.0±7.5 mins in group 1 while it was 58.8±14.0 mins in group 2 (p&lt;0.0001). Conclusions: Severe obesity does not alter surgical outcomes in patients undergoing PNL under spinal anesthesia, and in our opinion, spinal anesthesia in PNL is a safe and effective anesthesia modality for renal stone(s) in obese and morbidly obese patients.

A Clinical Study to Compare Efficacy and Safety of Combined Spinal-Epidural Anaesthesia over General Anaesthesia for Percutaneous Nephrolithotomy

A Clinical Study to Compare Efficacy and Safety of Combined Spinal-Epidural Anaesthesia over General Anaesthesia for Percutaneous Nephrolithotomy

A Critical Evaluation of Safety and Efficacy of Spinal Anesthesia in Comparison with General Anesthesia in Percutaneous Nephrolithotomy

A Critical Evaluation of Safety and Efficacy of Spinal Anesthesia in Comparison with General Anesthesia in Percutaneous Nephrolithotomy

A Prospective Randomized Comparative Study of Epidural Block and General Anesthesia for Percutaneous Nephrolithotomy for Hemodynamic Stability and Postoperative Analgesia

A Prospective Randomized Comparative Study of Epidural Block and General Anesthesia for Percutaneous Nephrolithotomy for Hemodynamic Stability and Postoperative Analgesia

Spinal vs. general anesthesia for percutaneous nephrolithotomy: A prospective randomized trial

ObjectiveTo compare the efficacy and safety of general anesthesia (GA) vs. spinal anesthesia (SA) in percutaneous nephrolithotomy (PCNL).MethodsTwo hundred patients were enrolled in a prospective randomized study to receive either GA or SA for PCNL. Patients’ characteristics, vital parameters, visual analog scale (VAS) and needs for additional analgesia were evaluated. Intraoperative and post-operative complications were recorded. Patients’ and surgeons’ satisfactions were also compared.ResultsVital parameters were maintained at safe values throughout procedures in both groups. Visual analog pain score was lower in SA group till 1 h postoperative in comparison with GA group (P < 0.05). Patients in SA group recorded lower consumption of analgesia in the 1st postoperative day in comparison with GA group (P < 0.05). Postoperative shivering was higher in SA group than GA group (8% vs. 2%) while nausea and vomiting was higher in GA group than SA group (5% vs. 2% and 4% vs. 1% respectively). Patients in GA group reported higher overall satisfaction scores than SA group (mean 9.6 ± 0.4 vs. 8.6 ± 0.8, P < 0.05). Similarly, surgeon’ satisfaction score was higher in favor of GA group compared with SA group (mean 10 ± 00 vs. 8.3 ± 0.4, P < 0.05).ConclusionsBoth GA and SA are effective and safe in PCNL. SA has fewer complications and lower consumption of analgesia postoperatively. However, GA provides more satisfaction for patients and surgeon.

Comparison Between Spinal and General Anesthesia in Percutaneous Nephrolithotomy

BackgroundHemodynamic stability and blood loss reduction are subjects to further consideration in patients undergoing percutaneous nephrolithotomy (PNCL).ObjectivesThis study compared the preference of spinal anaesthesia (SA) or general anaesthesia (GA) in respect to mentioned concerns.Patients and MethodsIn this randomized clinical trial, 59 patients who underwent PCNL divided into SA and GA groups. 15-20 mg from intra-thecal bupivacaine 0.5%, and premedication of 0.01-0.02 mg from midazolam, were given to patients in SA group (n = 29). Patients in GA group (n = 30) received premedication of 1-2 µg/kg from fentanyl and 0.01-0.02 mg/kg from midazolam, and intravenously anaesthetized with 100 µg/kg/min of propofol and 0.5 mg/kg of atracurium, given by continuous infusion and N2O/O2 50%. Mean arterial pressure (MAP) and heart rate were recorded intra-operatively and during recovery.ResultsMAP and heart rate show no significant differences at designated time points between two groups (P > 0.05). Surgery time, anesthesia time, bleeding volume, and analgesic intake were significantly reduced in SA group (P < 0.05).ConclusionsIt seems that, in patients undergoing PNCL, SA is as effective and safe as GA. Patients who undergo PNCL under SA require smaller amounts of analgesic dose and show hemodynamic stability during surgery and recovery time. Also, SA technique provides decreased blood loss and shortened surgery as well as anesthesia times compared to GA.

Anesthesia for percutaneous nephrolithotomy in a case of Kartagener′s syndrome

Anesthesia for percutaneous nephrolithotomy in a case of Kartagener′s syndrome

Haemothorax following Percutaneous Nephrolithotomy for Complete Staghorn Calculus

Anaesthesia for percutaneous nephrolithotomy using supracostal access for complex calculus problems poses unique challenges in terms of pulmonary injuries, haemorrhage, fluid absorption, dilutional anaemia and hypothermia.

Results and complications of spinal anesthesia in percutaneous nephrolithotomy.

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large kidney calculi, staghorn calculi, and calculi that are multiple or resistant to shock wave lithotripsy. In many centers, PCNL is performed under general anesthesia. However, complications under spinal anesthesia can be less frequent. We evaluated the impact of spinal anesthesia on intra-operative and postoperative outcome in patients undergoing PCNL. The intra-operative and postoperative anesthetic and surgical outcomes were evaluated in 160 consecutive patients who underwent PCNL under spinal anesthesia in the prone position. The mean age of the patients was 40.0 +/-14.3 years, and the mean operative time was 95.0 +/- 37.8 minutes. The mean calculus size was 34.2 +/- 9.8 mm. Ten patients had staghorn calculi (mean size, 4.2 +/- 1.1 cm; mean operative time, 140 +/- 40 minutes). Return of sensory and motor activity took 140.0 +/- 19.7 minutes and 121.0 +/- 23.8 minutes, respectively. During the first part of anesthesia, 18 patients developed hypotension, which was controlled by ephedrine, 10 mg, intravenously. Ten patients (6.3%) needed blood transfusion and 6 complained of mild to moderate headache, dizziness, and mild low back pain for 2 to 4 days after the operation, which improved with analgesics and bed rest. Seventy percent of the patients had complete clearance of calculus or no significant residual calculi larger than 5 mm on follow-up ultrasonography. Spinal anesthesia is safe and effective for performing PCNL and is a good alternative for general anesthesia in adult patients.

A Comparison of the Effects of Epidural Anesthesia, Lumbar Paravertebral Block and General Anesthesia in Percutaneous Nephrolithotomy

A Comparison of the Effects of Epidural Anesthesia, Lumbar Paravertebral Block and General Anesthesia in Percutaneous Nephrolithotomy