Percutaneous nephrolithotomy in anesthesia view: A 3-year experience of a referral hospital

Abstract

The aim of this study was to document the use of general anesthesia for patients who underwent percutaneous nephrolithotomy (PNL) during a 3-year period and to examine the current discussion related to anesthesia techniques in the context of the literature. Methods: Patients scheduled for PNL between 2015 and 2017 were assessed retrospectively. Patient demographic data, the characteristics of the renal stones, the duration of the operation, blood transfusion requirements, and complications of the PNL procedure and general anesthesia were evaluated. Results: A total of 521 patients were included in this study. The mean age was 48.32±0.61 years. The mean stone size was 22.48±0.47 mm. The mean duration of the operation was 106.30±1.56 minutes, and 79.07% of patients were stone-free after the procedure. The mean fluoroscopy time was 23.30±1.45 seconds and the mean irrigation fluid volume was measured as 8.70±0.23 L. The decrease in the hemoglobin and hematocrit levels after the procedure was statistically significant (p<0.0001), with a transfusion rate of 4.99%. Fever after surgery and hemorrhage not requiring blood transfusion were the major complications (13.4% and 10.74%, respectively) seen, using the Clavien classification system. Difficult intubation (1.2%), post-extubation laryngospasm (2.3%), refractory nausea (1.5%), bronchospasm (0.38%), ischemic electrocardiography changes (0.19%), and delirium (0.19%) were the major anesthesia problems. Conclusion: General anesthesia is a safe and effective method for PNL with well-known risks. Regional anesthesia techniques have also been reported in PNL procedures as an alternative to general anesthesia in recent years. Further clinical trials with large patient groups are needed to demonstrate the safety and efficacy of regional anesthesia in PNL.