Anesthetic management of surgical patients with renal cell carcinoma complicated by inferior vena cava tumor thrombus

Objective To highlight the anesthetic management of surgical patients with renal cell carcinoma（RCC） invading the inferior vena cava（IVC）. Methods Clinical data otained from 8 cases of RCC extending into the IVC（2 cases had retrohepatic IVC extension of RCC and 6 had tumor thrombus in infrahepatic IVC） were retrospectively analyzed. Results The operation time and duration of completely obstructed IVC were（473.6±98.6） min and（14.8±9.8） min,respectively. The average blood loss was（5 028.6±849.8） mL. Compared to the hemodynamic variables before IVC was clamped,the central venous and systolic blood pressures were decreased by 58.4%±12.3% and 33.6%±5.6%,respectively,after 5min. The heart rate was increased by 24.8%±13.7%. A case of ventricular fibrillation occurred in 1 case during the blockage of IVC and transient myocardial ischemia occurred in 2 cases after the IVC was opened. Acidosis occurred in all the cases. Dopamine,phenylephrine and 4% NaHCO3 were administrated. One case died of pulmonary emblolism during operation. Conclusion The key points to which anaethetists should be paid are the size of tumor and thrombus,the procedures of operation,auto-transfusion,function protection of the heart and kidney,and prevention of vital organ emblolism,especially pulmonary emblolism.