Anesthetic considerations during percutaneous nephrolithotomy

Study ObjectiveTo assess anesthesia-related complications during and following percutaneous nephrolithotomy (PCNL) for staghorn stones.DesignProspective study and a detailed case report.SettingMedical center in southern Israel.Patients20 consecutive patients undergoing PCNL for staghorn stones.InterventionsAll patients underwent PCNL during general anesthesia.MeasurementsDuration 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 ResultsMean 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.ConclusionsAnesthesia during PCNL for staghorn stones is a challenge because of the possibility of fluid absorption, dilutional anemia, hypothermia, or significant blood loss.