Anesthetic Safety During Percutaneous Nephrolithotomy

Abstract

Percutaneous nephrolithotomy has become the main management modality for large kidney stones because of small incisions, minimum complications and short hospital stay. Renal performance is determined by the study of renal hemodynamics, glomerular filtration, renal tubular function and urine analysis. Selection of patients and proper preoperative assessment is one of the milestones in percutaneous nephrolithotomy. Accuracy of surgical procedure with the use of modern instruments is very important to gain high rates of success and to limit intraoperative and postoperative complications. Although general anesthesia is preferred for performing percutaneous nephrolithotomy, regional and local anesthesia may be a good alternative especially in cases of staghorn stones and also in morbid obese patients. Peritubal local anesthetic infiltration and renal capsular block has been applied to alleviate postoperative pain. Percutaneous nephrolithotomy is generally a safe treatment option for kidney stones but associated with a low rate of complications such as injury of surrounding organs, bleeding, irrigation fluid extravasation, postoperative bleeding and fever. Complication of general anesthesia such as pulmonary and neurologic disorders, especially during change of the position is more likely than of spinal anesthesia. A well-standardised technique and postoperative follow up are mandatory for early detection of complications