Abstract
INTRODUCTION: Renal cell carcinoma has vascular invasion and extend into IVC and even into the right-sided cardiac chambers.Nephrectomy with thrombectomy provide palliation of symptoms with 5-year survival rate of 72% in absence of distant metastasis. AIMS AND OBJECTIVES:Anaesthetic management varies based on extension of tumour and is challenging due to IVC clamping,hemodynamic instability,potential for massive haemorrhage,and risk of intra operative tumour embolization. METHODOLOGY: A 62-year-old male hypertensive with COPD patient presented with pain in right lower back and haematuria. He was evaluated with USG abdomen, CT abdomen, confirming right RCC with thrombus extending into right renal vein and infradiaphragmatic IVC. The patient was planned for right radical nephrectomy with IVC thrombectomy. RESULT: The intra operative course was hemodynamically stable, except when the IVC was clamped during thrombectomy. Hypotension was managed with injection noradrenaline 0.03–0.05mcg/kg/min. Patient was extubated next morning as he was hemodynamically stable CONCLUSION: Successful anaesthetic management of RCC with IVC thrombus requires meticulous monitoring. Central venous pressure and hourly urine output monitoring can be used to achieve desired hemodynamic goals.
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