Hemodynamic instability associated with flank oblique supine modified lithotomy position in percutaneous nephrolithotomy under general anaesthesia: A case series

• Author Details:   
• Sathya Narayanan K
• Praveen Ramasamy
• Om Rajeshkumar
• Jethroben Kevin ^*

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Supine percutaneous nephrolithotomy (PCNL) has certain advantages over prone PCNL like easier surgical access, airway safety and minimal pressure effects that are well documented in the literature, albeit there is less information on cardiovascular benefits. We report a series of significant hypotension in ten patients undergoing PCNL in Flank-Free Oblique Supine Modified Lithotomy (FOSML) under general anaesthesia. The hypotension onset was immediate post positioning in FOSML necessitating intermittent vasopressor use until the patient was repositioned following surgery. Our results are in direct opposition to the theoretical haemodynamic stability attained in supine PCNL that has been reported in numerous urological journals.