Nephrectomy
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
Two large bore PIV, usually with a-line |
| Monitors |
Standard, +/- A-line |
| Primary anesthetic considerations | |
| Preoperative |
2u pRBC on standby, usually EKG, CBC, CMP |
| Intraoperative |
Avoid nitrous (bowel expansion), avoid extremities with AV fistula, and avoid forearm veins for patients who may need future dialysis, avoid potassium containing fluids in patients with impaired renal function |
| Postoperative |
hemorrhage, urinary fistula, UTI, DVT, wound infection, pleural effusion |
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| Editor rating | |
| User likes | 0 |
There are three categories for nephrectomies, depending on the extent of surgical involvement, these include: simple, partial, and radical nephrectomy.
A simple nephrectomy refers to the surgical removal of the affected kidney and small segment of the proximal ureter. Diagnoses warranting this procedure can include benign conditions, such as: hematuria, recurrent urinary tract infections, nephrolithiasis, hydronephrosis, flank pain, or kidney donation[1][2].
A partial nephrectomy refers to the surgical removal of the pathologic portion of the kidney. Diagnoses warranting this procedure can include: chronic hydronephrosis, hypoplastic kidney, renovascular hypertension, or a double collecting system[3].
A radical nephrectomy refers to the surgical removal of the affected kidney, with surrounding perinephric fat, Gerota's fascia, proximal 2/3 of the ureter, and can additionally include paracaval or para-aortic lymphadenectomy[3]. Diagnoses warranting this procedure are usually renal cell carcinoma or a double collecting system. Of note, if there is tumor or thrombus involving the vena cava or right atrium an interprofessional team involving cardiac surgery may also be involved.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | Renal hypertension |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Electrolytes, BUN, Cr. If indicated, perform additional workup for cardiac and pulmonary disease.
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
- Standard monitoring
- Arterial line
- Consider central line if IVC or RA thrombus
Induction and airway management
- Standard induction
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ "Nephrectomy". www.nephrologyspecialistsoftulsa.com. Retrieved 2022-02-02.
- ↑ "Simple Nephrectomy". urology-textbook.com. Retrieved 2022-02-02.
- ↑ 3.0 3.1 Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404.
|edition=has extra text (help)CS1 maint: others (link)
Top contributors: Olivia Sutton, Josh Calvano and Chris Rishel