CC BY-NC-ND 4.0 · Journal of Health and Allied Sciences NU 2011; 01(04): 46-49
DOI: 10.1055/s-0040-1703541
Case Report

PATIENT UNDERGOING COMBINED RIGHT RADICAL NEPHRECTOMY AND RIGHT ATRIAL TUMOUR EXCISION: ANAESTHETIC MANAGEMENT

Manjunath R. Kamath
1  Department of Anaesthesia, Justice K.S. Hegde Charitable Hospital, Nitte University, Mangalore, Karnataka - 575 018, India
,
Krishna Prasad P.
1  Department of Anaesthesia, Justice K.S. Hegde Charitable Hospital, Nitte University, Mangalore, Karnataka - 575 018, India
,
Mundayat Gopalakrishnan
2  Cardiothoracic and Vascular Surgery, Justice K.S. Hegde Charitable Hospital, Nitte University, Mangalore, Karnataka - 575 018, India
,
Rajeev T. P.
3  Urology, Justice K.S. Hegde Charitable Hospital, Nitte University, Mangalore, Karnataka - 575 018, India
› Author Affiliations

Abstract

We describe anaesthetic management of a rare case of right atrial tumour with right renal mass posted for combined excision of right atrial tumor and right radical nephrectomy. Anaesthesia plan was combined thoracic epidural anaesthesia & general anaesthesia. Right renal mass was removed through the anterior subcostal incision, followed by the right atrial mass excision through the midline sternotomy incision under cardiopulmonary bypass. Issues related to the possibility of inferior vena cava (IVC) thrombus & its extension into the right atrium and the subsequent removal, pain management, ideal position of the central venous access, cardiopulmonary bypass with a single kidney are discussed.



Publication History

Publication Date:
27 June 2020 (online)

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Thieme Medical and Scientific Publishers Private Ltd.
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  • References

  • 1 Bruke A, Virmani R. In: Tumors of the heart and great vessels: Atlas of Tumor Pathology. 3rd series, fascicle 16. Washington, DC: Armed Forces Institute of Pathology 1995:171-7.
  • 2 Hatcher PA, Anderson EE, Paulson DF, Carson CC, Robertson JE. Surgical management and prognosis of renal cell carcinoma invading the vena cava. J. Urol. 1991; 145:20–4.
  • 3 Livi U, Bortolotti U, Milano A, Valente M, Prandi A Frugonic C, et al. Cardiac myxomas: results of 14 years' experience. Thorac Cardiovasc Surg. 1984; 32:143-7.
  • 4 Reynen K. Cardiac myxomas. N Engl J Med 1995; 333:1610-17.
  • 5 Allen G, Klingman R, Ferraris VA, et al. Trans oesophageal echocardiography in the surgical management of renal cell carcinoma with intracardiac extension. J Cardiovasc Surg (Torino) 1991; 32(6):833-6.
  • 6 Van Camp G, Abdulsater J, Cosyns B, Liebens I, Vandenbossche JL. Transesophageal echocardiography of right atrial metastasis of a hepatocellular carcinoma. Chest 1994; 105(3):945-7.
  • 7 Mulders PF, Brouwers AH, Hulsbergen-van der Kaa CA, van Lin EN, Osanto S, de Mulder PH (February 2008). "[Guideline 'Renal cell carcinoma']" 152 (7): 376–80.
  • 8 Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004; 94:33-41.
  • 9 Rini BI, Rathmell WK, Godley P (May 2008). "Renal cell carcinoma". Curr Opin Oncol 20(3):300–6.
  • 10 Skinner DG, Pritchett TR, Lieskovsky G, Boyd SD, Stiles QR. Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann Surg. 1989; 210:387-92.
  • 11 Oto A, Herts BR, Remer EM, Novick AC. Inferior vena cava tumor thrombus in renal cell carcinoma: staging by MR imaging and impact on surgical treatment. AJR Am J Roentgenol. 1998; 171:1619-24.