Anesthetic Implications of Prone Position Percutaneous Nephrolithotomy in a Deformed DWARF

Abstract

Introduction: Abnormal body habitus can lead to difficulties with patient positioning, tracheal intubation and regional anaesthesia. Case report: We report the anesthetic management of a 47 year old male with short stature and extreme bony deformity complaining of bilateral flank pain. Percutaneous nephrolithotomy (PCNL) under general anesthesia in prone position was done. Perioperative course was uncomplicated and patient was discharged without any untoward event on day seven. This report highlights anesthesia related issues surrounding extreme skeletal deformities and prone positioning during PCNL. Conclusion: Prone positioning is associated with physiological changes and number of complications and safe use of the prone position in this case requires an understanding of both issues. In practice providing anesthesia in such a patient even for a minimally invasive surgical intervention requires us to "think out of the box". Thus the use of modern anesthetic agents and relevant anesthesia techniques had increased the margin of safety for our patient.