Anesthesia Related Pneumothorax, Hydrothorax or Hemothorax in Patients Undergoing Percutaneous Nephrolithotomy in Srinagarind Hospital

Abstract

Background and objective: Percutaneous nephrolithotomy (PCNL), a minimal invasive surgery, has many benefits to the patients i.e., smaller wounds, less pain, and shorter hospital stay. However, the patients may have some serious complications, i.e., pneumothorax, hydrothorax, or hemothorax. Unless prompt detection and treatment, these complications may lead to respiratory failure and death. The objective of our study is to identify the incidence of these complications and contributing factors of delayed detection so that we can use as information for institutional quality improvement.

Methods: This study is a retrospective and descriptive study. We recruited patients undergoing PCNL between January 2007 and December 2010.

Results: We recruited 755 PCNL patients and found six cases of pneumothorax,  hydrothorax or hemothorax.  The incidence was 79.5 : 10,000. Most of them were males and the ages were between 15-64 years. All stones were in upper pole and the trocars were inserted by supracostal access.  The contributing factors of delayed detection were inexperienced personnels, inappropriate decision making, incomplete patient evaluation, and lack of knowledge.  The factors that may minimize delayed detection were high vigilance, good communication, and well experienced personnels.

Conclusions: We reported cases of pneumothorax, hydrothorax or hemothorax during PCNL under general anesthesia.  The incidence was 79.5 : 10,000.  All of them had stones in upper poles with supracostal access trocars insertion. The major contributing factor of delayed detection was inexperienced personnel. To minimize the delayed detection, the anesthesia personnel should have high vigilance, good communication, and good experience.

Key words : Pneumothorax, Hydrothorax, Hemothorax, PCNL :  Percutaneous nephrolithotomy