Anaesthesia for supine and modified supine PNL

Abstract

Anaesthetists need to be aware of the difficulties and complications specific to PNL, a well-established endourological means of kidney stone removal. Although traditionally PNL has been performed in the semi-prone or prone position, more recently some centres have been successfully performing the procedure in a supine or modified supine position. This presents some signifi cant advantages from the viewpoint of the anaesthetist, as well as a small number of disadvantages. However, many of the anaesthetist’s concerns regarding PNL are similar whatever the position used. Patient’s features and co-morbidities should be preliminarily evaluated in order to choose the best anaesthetic technique. Intraoperative management is also described, facing not only specific PNL complications such as blood loss or septic risk but also often overlooked issues including fluid balance and thermal control.