Percutaneous Nephrolithotomy: Current Clinical Opinions and Anesthesiologists Perspective

Abstract

Percutaneous nephrolithotomy (PCNL), a minimally invasive method for removal of renal calculi, was initially started in the 1950s but gained popularity about two decades later and has now become standard practice for management. There has been an immense improvement in technique and various guidelines have been established for treatment of renal stones. However, it has its own share of complications which can be attributed to surgical technique as well as anesthesia related complications. PubMed and Google search yielded more than 30 articles describing the different complications seen in this procedure, out of which 15 major articles were selected for writing this review. The aim of this review article is to describe the implications of the complications associated with PCNL related to the anesthesiologist. The anesthesiologist is as much responsible for the management of the patient perioperatively as the surgeon. Therefore, it is mandatory to be familiar with the various complications, some of which may be life threatening and he should be able to manage them efficiently. The paper also analyses the advantages and drawbacks of the available options in anesthesia, that is, general and regional, both of which are employed for PCNL.

Usage of Multilevel Paravertebral Block as the Main Anesthesia for Mini-Invasive PCNL: Retrospective Review of 45 Cases with Large Stones

“…Usually, GA is considered the safest method to ensure the security of a patient's airway in the prone position, to control tidal volume during percutaneous puncture to avoid injury to the pleura and lungs, and to prolong anesthesia duration in case of large stone load [10] . RA was first described in PCNL in 1988 [11] ; since then more and more reports demonstrated the advantages of RA over GA for PCNL because patients are conscious and can position themselves when RA is applied [4,12,13] .…”

Anesthetic considerations for urologic surgeries

“…Percutaneous nephrolithotomy (PCNL) is commonly performed to treat renal stone. The indication of PCNL includes > 1.5-2 cm of renal calculi, staghorn calculi, lower pole stone, and refractory upper tract calculi [69,70]. Patients are placed in prone position under either general or spinal anesthesia.…”

“…Patients are placed in prone position under either general or spinal anesthesia. The advantages of general anesthesia are securing airway even in prone position and minimizing pleural injury by control of tidal volume during the procedure [70]. However, there is a risk of pressure on the eyes, ears, nose, and any bony structure in the prone position.…”

KingVision® and dexmedetomidine for opioid-free awake intubation in a patient with Klippel-Feil syndrome for complex percutaneous nephrolithotomy in a prone position: a case report

“…The advantages offered by GA include safety because the patient's airway is secured in prone position, feasibility to control tidal volume during percutaneous access puncture to minimise injury to the pleura and lungs, and prolonged anaesthesia duration allowing the surgeon to make multiple and higher punctures with minimal patient discomfort, especially in cases with large stone load. It is safe to conduct the procedure under GA for complicated or prolonged procedures [2][3][4].…”