PERCUTANEOUS NEPHROLITHOTOMY (PCNL)
Percutaneous Nephrolithotomy (PCNL) is a surgical procedure used to remove kidney stones. In this procedure, a small incision is made in the patient's back, and a nephroscope (a special type of endoscope) is inserted directly into the kidney. The kidney stones are then either extracted or broken down into smaller pieces using laser or ultrasonic devices. This method is typically used for larger stones or when other treatments like extracorporeal shock wave lithotripsy (ESWL) are not effective.
"Percutaneous" means through the skin
Nephrolithotomy: nephro- (kidney), litho-(stone), and -tomy (removal)
Nephrolithotripsy: nephro- (kidney), litho (stone), and -tripsy (crushed)
Anesthetic Implications for Percutaneous Nephrolithotomy (PCNL)
Anesthesia type: General
Airway: ETT
Preoperative:
-
Elderly patients may have many comorbidities
-
Patients may have hydronephrosis causing deranged renal functions and sepsis
-
Avoid pressure on the eyeballs in the prone position
-
Maintain cervical neutrality
-
Fluoroscopy/xray considerations (lead aprons and thyroid shields)
-
Paraplegics and quadriplegics have the risk of developing autonomic hyperreflexia
Intraoperative:
-
Fiberoptic nephroscope is inserted into the kidney through a small flank incision
-
Position: prone or lateral
-
Duration: 1-2 hours
Postoperative:
-
Postoperative fevers may occur
Complications:
-
Injury to the pleura and lungs
-
Pneumothorax
-
Injury to major blood vessels
-
Bleeding
-
Hepatic or splenic injury
-
Bowel injury
-
Accidental extubation and kinking of endotracheal tube
-
Facial and ocular edema when prone position
-
Volume overload
-
Electrolyte imbalances
Sources:
Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.
Vacanti, C., Segal, S., Sikka, P., & Urman, R. (Eds.). (2011). Essential Clinical Anesthesia (1st ed.)