SRINAGARIND MEDICAL JOURNAL

Volume 35, No. 06, Month NOVEMBER, Year 2020, Pages 669 - 673

Continuous quality improvement of clinical practice guideline for management of patients undergoing percutaneous nephrolithotomy under general anesthesia in srinagarind hospital

Wilawan Somdee, Sirirat Tribuddharat, Thepakorn Sathitkarnmanee, Wichien Sirithanaphol, Narin Plailaharn, Pakorn Kiatsopit, Ukrit Rompsaithong, Suthannee Simajareuk, Viriya Thincheelong, Khochakorn Palachewa

Abstract Download PDF

nephrolithotomy (PCNL) is a minimal invasive surgery for treatment of renal calculi. It may cause pleural cavity injury, i.e., pneumothorax, hydrothorax, or hemothorax (P/H/H), which mostly occurs in supracostal access of trocar puncture. The previous practice guideline requires that, for safety, endotracheal tube must be retained at the end of surgery in all patients undergoing PCNL with supracostal access leading to patient discomfort and agitation. They were extubated after pleural cavity injury was assessed using portable CXR at PACU. To reduce patient discomfort, we improved the guideline using PaO2/FiO2 (P/F) ratio ≤ 300 mmHg as criteria to retain endotracheal tube in these patients. The objective of this study was to evaluate the efficacy of the new guideline. Methods: This was a prospective, descriptive study. We included all adults undergoing elective PCNL at Srinagarind hospital, Khon Kaen university between July 2017 and November 2018. We identified the incidence of endotracheal tube retaining and pleural cavity injury. Results: Forty-seven patients were included. There were 20 cases (42.6%) with supracostal access. Among supracostal patients, there were 9 cases (45%) with P/F ratio ≤ 300 mmHg who required endotracheal tube retaining with 2 cases (4.3%) complicated with hydrothorax and 3 cases (6.4%) with sepsis. Conclusions: The improved guideline using P/F ratio ≤ 300 mmHg as criteria to retain endotracheal tube in patients undergoing PCNL with supracostal access can reduce incidence of endotracheal tube retaining from 100% to 45% without complications. The incidences of pleural cavity injury and sepsis were 4.3% and 6.4%.

Keywords

Percutaneous nephrolithotomy PCNL PaO2 FiO2 ratio Endrotrachial tube Agitate

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