[Septic attack during percutaneous nephrolithotripsy under epidural anesthesia]

A 59-year-old man was scheduled for percutaneous nephrolithotripsy (PNL) for renal calculus. Anesthesia was maintained by epidurally administered mepivacaine 1.5% under prone position. During surgical manipulation, the patient complained of shivering and chill accompanied with fever and tachycardia. His temperature peaked at 40.7 degrees C and decreased gradually by cooling. Serratia was detected from arterial blood obtained in the operating room. It was thought that fever attack was due to excessive increase of intrarenal pressure by irrigation fluid which might have led to septicemia. Therefore, careful attention for septic attack must be paid during PNL procedure as well as postoperatively.