Balanced general anesthesia in tumor thrombectomy in the vena cava and right atrium with radical nephrectomy

case report

Abstract

Introduction: Among malignant tumors in adults, kidney tumors account for 2 to 3% of cases. Renal cell carcinoma has a predisposition to vascular invasion, presenting inferior vena cava thrombus in 4 to 10% of patients, extending to the right atrium in approximately 1% of cases. Tumor thrombectomy is the gold standard treatment, increasing the survival rate of these patients. Case Report:  Individual undergoing tumor thrombectomy in the vena cava and right atrium associated with radical nephrectomy. In the surgical center, the patient was properly monitored. Important component signs, required for a balanced general anesthesia. Pre-oxygenation under a face mask at 10 l/min, induction with ketamine, dexmedetomidine, lidocaine, sulfentanil, propofol and rocuronium. And anesthetic maintenance with sevoflurane and remifentanil pump. Intraoperatively, dissection of the renal area and exposure of the vena cava began. Then, a sternotomy was performed and extracorporeal circulation was started, with a successful tumor thrombectomy. During the surgery, without complications and at the end, the patient was still under mechanical ventilation to the intensive care unit, extubated in less than 24 hours, with electrical signs and without any allergic complaints. Discussion: Tumor thrombus within the inferior vena cava and/or right atrium is a relatively rare occurrence, when arising from renal and adrenal tumors. Atrial invasion is relatively rare and affects only 1% of cases with vascular invasion. Perioperative assessment and determination of the level of tumor thrombus is extremely important for determining the operative and anesthetic proposal.