Supine Percutaneous Nephrolithotomy (PCNL): Current Status | Chapter 5 | Newer Frontiers in Urology, Volume II

 

Background: Percutaneous nephrolithotomy (PCNL) remains the standard treatment for large (>20 mm), staghorn, and complex renal calculi. Although the prone position has traditionally been preferred, it is associated with anaesthetic challenges, longer operative times due to repositioning, and ergonomic limitations. Supine PCNL, particularly in the Galdakao-modified supine Valdivia position, has re-emerged as an alternative that may improve perioperative safety, workflow efficiency, and facilitate combined antegrade–retrograde intrarenal surgery (ECIRS).

 

Objective: To review the current status of supine PCNL, focusing on its procedural principles, indications, outcomes, complications, and comparative effectiveness relative to prone PCNL.

 

Methods: A narrative review was performed synthesising evidence from comparative studies, randomised trials, meta-analyses, and large observational series evaluating supine PCNL. Key aspects analysed included patient selection, positioning techniques, access and tract creation, intraoperative workflow, adjunctive ECIRS, anaesthetic and ergonomic considerations, postoperative strategies, and reported clinical outcomes.

 

Results: Across most indications, supine PCNL demonstrates stone-free and complication rates comparable to prone PCNL. Supine positioning consistently reduces operative and anaesthesia time by eliminating intraoperative repositioning and improves airway access and hemodynamic stability, particularly in obese and high-risk patients. ECIRS is more readily feasible in the supine position, narrowing any potential disadvantage in complete staghorn calculi. Bleeding, infection, and visceral injury rates are similar between positions when appropriate patient selection and imaging-guided access are employed.

 

Conclusion: Supine PCNL is a safe, efficient, and versatile alternative to prone PCNL that aligns with contemporary goals of patient-centred care, anaesthetic safety, and surgical ergonomics. With appropriate training and case selection, it achieves outcomes equivalent to the prone approach while offering distinct workflow and physiologic advantages.

 

 

Author(s) Details

Bhavyadeep Korrapati
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Vijayanand Mani
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Velmurugan Palaniyandi
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Hariharasudhan Sekar
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

Sriram Krishnamoorthy
Department of Urology and Renal Transplant, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

 

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH5

A Comprehensive Review of Thromboprophylaxis and Its Implications in Regional Anaesthesia | Chapter 12 | Medical Science: Recent Advances and Applications Vol. 7

 

Venous thromboembolism, comprising both Deep Venous Thrombosis and Pulmonary Embolism, is a chronic illness. VTE is an important cause of postoperative morbidity and mortality, especially when patients with co-morbid conditions (like obesity, coronary artery disease, or cancer) are on the rise. This necessitates the use of various thromboprophylaxis measures to prevent the occurrence of fatal VTE. However, the pharmacological thromboprophylaxis carries an inherent risk of bleeding, especially when the area of invasive work involves a potential space with a risk of non-compressible arterial puncture. During neuraxial anaesthesia, such bleeding into a closed space can result in spinal hematoma, which carries various neurological sequelae and requires urgent diagnosis and management.

 

The aim of the study is to review and analyse the relevant literature on the modalities of thromboprophylaxis, their mechanism of action and optimal management of such patients in the perioperative setting. In the perioperative setting, managing a patient on thromboprophylaxis therapy is still challenging, and with the introduction of various newer anticoagulants, management becomes more perplexing. In view of limited randomised trials pertaining to the thromboprophylaxis management in regional anaesthesia settings, a thorough knowledge of the mechanism and duration of action of these anticoagulant drugs, as well as recommended guidelines, is essential for the effective management of such patients.

 

Author(s) Details

Ragi Jain
Department of Anesthesia, Santosh Medical and Dental College and Hospital, Ghaziabad (Uttar Pradesh), India.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v7/5736

The Anesthesia Conundrum: Unraveling Patients' Knowledge, Perception, and Satisfaction | Chapter 4| Achievements and Challenges of Medicine and Medical Science Vol. 10

Background: Anaesthetists perform a vital and multifaceted role in patient care, yet their interactions with patients are often limited, primarily occurring when the patient is unconscious or sedated. Consequently, many patients remain unaware of the extensive range of responsibilities anaesthetists undertake, both within and beyond the operating theatre. This study aims to investigate patients’ understanding and perceptions of anaesthesia and the role of anaesthetists in a tertiary healthcare facility.

Methodology: This was an institution-based, cross-sectional study conducted between March 2022 and December 2022 at Government Medical College Srinagar and its affiliated hospitals. A total of 1000 patients, following informed written consent, were surveyed during their pre-anaesthetic evaluations. Participants completed a structured questionnaire designed to assess their knowledge and perceptions of anaesthesia and the anaesthetist's role within the healthcare system.

Results: Despite their essential contribution to the seamless operation of healthcare systems, anaesthetists’ roles often remain undervalued and underappreciated by both patients and, at times, other medical professionals. Public awareness of the diverse and critical functions anaesthetists perform—ranging from perioperative management and emergency resuscitation to critical care, chronic pain management, and palliative care—remains markedly limited.

Conclusion: Anaesthetists are frequently perceived in a poor light, with many patients unaware that they are indeed medical doctors. To remedy this misconception, anaesthetists should engage in proactive communication with patients, elucidating the indispensable role they play in patient care, safety, and overall well-being.

 

Author (s) Details

 

Sana Khan
Department of Anaesthesiology and Critical Care, GMC Srinagar, India.

 

Mudasir Amin
Department of Neurosurgery, SKIMS Srinagar, India.

 

Tantry Tariq Gani
Department of Anaesthesiology and Critical Care, GMC Srinagar, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v10/3612

Fundamental Physics in Anaesthesia | Chapter 4 | New Trends in Physical Science Research Vol.7

 

 For a safe anaesthesia outcome, anesthesiologists oversee and manage the administration of several anaesthetic agents, including volatile liquids and gases, to the patient using various delivery methods. The behaviour of these gases and liquids might vary depending on the kind of atmosphere. Anesthesiologists should also have a thorough understanding of the physics involved with delivery or safety equipment. No gadget is fail-proof, and this understanding may be very helpful in resolving issues when a device fails. By avoiding the introduction of hypoxic gas in an emergency, this information can also save lives. Therefore, it is important to thoroughly study the physics of the various drugs utilised by anesthesiologists.

Author(s) Details:

Anshul Goyal,
Maulana Azad Medical College, New Delhi, India.

Lalit Gupta,
Maulana Azad Medical College, New Delhi, India.

Shikha Modi,
Maulana Azad Medical College, New Delhi, India.

Rohit Priyadarshi,
Jamia Milia Islamia, New Delhi, India.

Please see the link here: https://stm.bookpi.org/NTPSR-V7/article/view/7780

Glycoconjugates Study in Surface Secretions of a Fresh Water Edible Catfish, Clarias gariepinus in Response to Clove Oil Anaesthesia: Experimental Investigation | Chapter 4 | New Innovations in Chemistry and Biochemistry Vol. 3

 This histopathology and histochemistry study looks at the effects of clove oil anaesthesia on the gills, dendritic organs, and skin of Clarias gariepinus, a locally available fresh water edible catfish. Clove oil has long been known for its medical properties, and it was/is extensively used as an analgesic and antiseptic. Surface organs in C. gariepinus include the gills, dendritic organs, and skin, which are in direct contact with the surrounding water and hence give a larger surface area of absorption for any xenobiotics, including the clove, and were thus chosen for examination. Clove oil, obtained from the Syzygium aromaticum plant's flower buds, leaves, and stems, has recently been introduced as an effective anaesthetic agent in the fishing industry for a variety of uses. C. gariepinus with a total length of 30 2 cm and a weight of 200 5 g was exposed to clove oil concentrations ranging from 0.07 ml/l to 0.3 ml/l (LOBA CHEM. PVT. LTD, MUMBAI, Minimum assay 85 percent). C. gariepinus displayed erratic swimming, bubbling, rubbing against the side and bottom walls of the glass aquarium, and protrusion of the head above the water surface during clove oil exposures. As their opercular motions cease and their balance is lost, fish, on the other hand, become static and horizontal. Clove oil anaesthesia alters the mucogenic characteristics of all surface organs, leading the surface to exude more Alcian Blue pH 2.5 positive mucus and slime. Wear and tear of the epithelial linings of the gills, destruction of vascular components, blood seeping on the surface of dendritic organs, and lifting of the gill epithelium are all adverse effects of clove oil anaesthesia in C. gariepinus.

Author(S) Details

Ajai Kumar Singh
Post Graduate Department of Zoology, R. K. Talreja College of Arts, Science & Commerce, Ulhasnagar-3 (MS), India.

View Book:- https://stm.bookpi.org/NICB-V3/article/view/4008