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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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

  1. "Nephrectomy". www.nephrologyspecialistsoftulsa.com. Retrieved 2022-02-02.
  2. "Simple Nephrectomy". urology-textbook.com. Retrieved 2022-02-02.
  3. 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)