Korean J Anesthesiol.  1998 Jul;35(1):181-185. 10.4097/kjae.1998.35.1.181.

Anesthetic Management of Patient with Renal Cell Carcinoma Extending into the Right Atrium Using Adjunctive Deep Hypothermic Circulatory Arrest: A case report

• Kim DK
• Kim HC
• Choi IH
• Ham BM

• KMID: 2298929
• DOI: http://doi.org/10.4097/kjae.1998.35.1.181

Abstract

Renal cell carcinoma is associated with inferior vena cava tumor spread in 4~10% of cases and with extension of the tumor thrombus into the right atrium in less than 1% of cases. Because inferior vena caval involvement does not affect the ultimate survival in patients with nonmetastatic renal cell carcinoma, aggressive surgical resection is indicated. We experienced a case of complete tumor excision with radical nephrectomy and inferior vena caval and right atrial thrombectomy using adjunctive cardiopulmonary bypass(CPB) and deep hypothermic circulatory arrest(DHCA). During total circulatory arrest(TCA), we protected brain from ischemic insult using deep hypothermia, retrograde cerebral perfusion, thiopental, and high dose steroid. The patient recovered uneventfully except minor neuropsychiatric symptom for 3 weeks after operation.

Keyword

Brain: hypoxia; brain protection; Cancer: renal cell carcinoma; inferior vena cava thrombosis; Heart: total circulatory arrest; DHCA; retrograde cerebral perfusion; Pharmacology: thiopental

MeSH Terms

Brain
Carcinoma, Renal Cell*
Circulatory Arrest, Deep Hypothermia Induced*
Heart Atria*
Humans
Hypothermia
Nephrectomy
Perfusion
Thiopental
Thrombectomy
Thrombosis
Vena Cava, Inferior
Thiopental