| Anesthetic Management of Patient with Renal Cell Carcinoma Extending into the Right Atrium Using Adjunctive Deep Hypothermic Circulatory Arrest: A case report. |
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Duck Kyoung Kim, Han Chul Kim, Ik Hyun Choi, Byung Mun Ham |
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Department of Anesthesiology, Collage of Medicine, Seoul National University, Seoul, Korea. |
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| Abstract |
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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. |
| Key Words:
Brain: hypoxia; brain protection; Cancer: renal cell carcinoma; inferior vena cava thrombosis; Heart: total circulatory arrest; DHCA; retrograde cerebral perfusion; Pharmacology: thiopental |
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