Anesthetic considerations during percutaneous nephrolithotomy

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.