A Prospective Observational study to determine the incidence of perioperative complications during Percutaneous Nephrolithotomy (PCNL) Surgery and the various risk factors predisposing to them

Suma Mary, Thampi (2010) A Prospective Observational study to determine the incidence of perioperative complications during Percutaneous Nephrolithotomy (PCNL) Surgery and the various risk factors predisposing to them. Masters thesis, Christian Medical College, Vellore.


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BACKGROUND: Percutaneous nephrolithotomy (PCNL) is a relatively non-invasive surgical alternative available for removal of kidney stones. The traditional approach to renal stones was through open surgical procedures that required general anesthesia and long convalescence. Although, PCNL is a minimal invasive technique, it carries a potential risk of complications. These include bleeding, anaemia, hypotension, hyponatremia, hypothermia, injury to vital organs like pleural tear bowel perforation, infection, and septic shock. PCNL is a very common surgery that is being carried out in our institution. However, till date the there has been no study on the profile of complications that have been observed perioperatively. In literature, though the listed complications do not actually quantify their incidence. Considering the frequency of cases and complications seen, we feel that it would be a very useful exercise, since knowing the relative incidence of complications will help institute the appropriate monitoring techniques and so, in the better perioperative management. AIM OF THE STUDY: To assess the peri-operative anaesthetic complications of Percutaneous Nephrolithotomy (PCNL). OBJECTIVES: 1. To detect the incidence of cardiovascular changes namely hypotension and arrhythmias during the surgery. 2. To detect the incidence of hypothermia during the surgery. 3. To detect the incidence of bleeding requiring intra-operative blood transfusion. 4. To detect the incidence of acidosis resulting from the procedure. 5. To detect the incidence of any other complication that may result due to the surgery. 6. To determine risk factors associated with each of the above complication. METHODS: Data was collected on 60 patients who underwent elective PCNL surgery. This included monitoring of blood pressure, heart rate, nasopharyngeal temperature, saturation, end-tidal carbon-di-oxide, arterial blood gas (ABG), the volume and temperature of irrigation fluid, the temperature in the operating. The collected data was analyzed to find out the complications that occur during the procedure and to determine their incidence and risk factors associated with them. Data was analyzed using SPSS version 16. Chi-square test was the test of significance in the study. Odds Ratio was calculated and a p-value less than 0.05 was considered statistically significant. RESULTS: A total of 60 patients were studied of whom 42 were females and 18 males. 40 patients were ASA grade 1 and 20 were ASA grade 2.The incidence of hypothermia and acidosis was 60% and 26.7%, respectively. The incidence of hypothermia and temperature of the irrigating fluid had statistically significant association with a p-value of 0.026.The incidence of acidosis was significantly associated with the volume of irrigating fluid with a p-value 0.025.The risk of acidosis was increased with hypothermia (p-value 0.02 and OR 7.00). CONCLUSION: The most common complication observed intraoperatively was hypothermia, followed by acidosis and sepsis. Other complications that occurred were excessive bleeding and hydrothorax. Electrolytes imbalance and cardiovascular changes were not observed as major complications. The most significant risk factor associated with hypothermia was found to be the usage of cold irrigating fluid.

Item Type: Thesis (Masters)
Uncontrolled Keywords: perioperative complications ; percutaneous nephrolithotomy (PCNL) surgery ; risk factors ; predisposing ; prospective observational study.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 30 Apr 2018 02:53
Last Modified: 30 Apr 2018 02:53
URI: http://repository-tnmgrmu.ac.in/id/eprint/7322

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