Neurologic Complications in Percutaneous Nephrolithotomy

PURPOSE: Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. RESULTS: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. CONCLUSIONS: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

Prevention of bradycardia by atropine sulfate during urological laparoscopic surgery. A randomized controlled trial

Cardiac arrhythmias are well-recognized complication of anesthesia for laparoscopy. The aim of this study was to evaluate the efficacy of atropine sulfate for prevention of bradyarrhythimia during laparoscopic surgery. Sixty-four candidates for urological laparscopic surgery were randomly assigned into 2 groups to receive either atropine sulfate or hypertonic saline solution [as placebo], intravenously 3 minutes before induction of anesthesia for the laparoscopic procedure. Then, all of the patients underwent anesthesia intravenous sodium thiopental and atracurium, followed by isoflurane or halothane inhalation. Heart rate and blood pressure were recorded preoperatively in the recovery room, preoperatively in the operation room, after induction of anesthesia, after induction of pneumoperitoneum, and postoperatively. A significant decreasing trend was seen in the heart rates during the operation in patients without atropine sulfate. Nine of 32 patients [28.1] in this group developed bradycardia, while none of the patients with atropine sulfate prophylaxis had bradycardia perioperatively [P<.001]. The mean decreased in systolic blood pressure between induction of anesthesia and pneumoperitoneum were 15.7 +/- 10.02 mm Hg in group 1 and 23.5 +/- 9.8 mm Hg in group 2 [P<.001]. The mean decreases in diastolic blood pressure between these two measurements were 8.7 +/- 5.2 mm Hg in group 1 compared to 12.1 +/- 6.2 mm Hg in group 2 [P=.001]. This study suggests that routine prophylaxis with an anticholinergic agent might be helpful in prevention of sinus bradycardia during urological laparoscopic surgery

Laparoscopic adrenalectomy ten-year experience, 67 procedures

The purpose of this study was to evaluate the short-term and long-term results of laparoscopic adrenalectomies carried out in our center. A total of 67 laparoscopic adrenalectomies were performed during the 10 years between 1995 and 2005 at Shahid Labbafinejad Medical Center. A transperitoneal lateral approach was used in 65 [97.0%] of the patients, and retroperitoneal approach was used in 2 [3.0%]. The clinical characteristics and the outcomes were reviewed in a retrospective study. Indications for laparoscopic adrenalectomy in our patients were as follows: pheochromocytoma in 28 patients [41.8%], aldosterone-producing adenoma in 15 [22.4%], pseudocyst in 6 [9.0%], Cushing syndrome [macronodular adrenocortical hyperplasia] in 5 [7.5%], nonfunctioning adenoma [incidentaloma] in 5 [7.5%], myelolipoma in 2 [3.0%], almost normal adrenal tissue in 2 [3.0%], adrenal cyst in 2 [3.0%], adenocarcinoma in 1 [1.4%], and schwannoma in 1 [1.4%]. The mean operative time for unilateral cases was 149.0 A +/- 36.1 minutes. The mean intraoperative blood loss was 126 A +/- 36 mL. Conversion rate to open surgery was 7.5%. Reoperation due to hemorrhage was performed in 1 patient. Laparoscopic adrenalectomy is a safe procedure in some adrenal tumors and a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion