Pediatric Partial Nephrectomy/Heminephrectomy Anesthesia - AnethAssist

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Pediatric Partial Nephrectomy or Heminephrectomy — What it is

Nephron-sparing removal of a nonfunctioning renal moiety or localized lesion; pyeloureterostomy may preserve an obstructed but functioning upper pole.

Pediatric Partial Nephrectomy or Heminephrectomy — Common indications

Nonfunctioning upper-pole duplex system, ureterocele, ectopic ureter, bilateral Wilms tumor, angiomyolipoma, or another localized renal mass.

Pediatric Partial Nephrectomy or Heminephrectomy — Position

Flank or prone; abdominal tumor exposure may require supine positioning.

Pediatric Partial Nephrectomy or Heminephrectomy — Surgical access

Dorsal lumbotomy, subcostal flank, laparoscopic, chevron, or midline exposure according to moiety location and tumor extent.

Pediatric Partial Nephrectomy or Heminephrectomy — Typical duration

Approximately 2.5 h.

Pediatric Partial Nephrectomy or Heminephrectomy — Expected blood loss

Approximately 300 mL for partial nephrectomy.

Pediatric Partial Nephrectomy or Heminephrectomy — Pain and stimulation

Pain score 10 after flank incision and 5 after dorsal lumbotomy.

Pediatric Partial Nephrectomy or Heminephrectomy — Anesthetic options

GETA with active warming and optional epidural when coagulation is normal; adjust drugs, fluids, and neuromuscular blockade for renal insufficiency.

Pediatric Partial Nephrectomy or Heminephrectomy — Airway

Consider modified RSI for renal-failure-associated reflux or delayed gastric emptying; secure and recheck the ETT after positioning.

Pediatric Partial Nephrectomy or Heminephrectomy — IV and blood preparation

Use an upper-extremity IV, additional access, and blood availability; protect dialysis access and avoid potassium-containing crystalloid in oliguric renal failure.

Pediatric Partial Nephrectomy or Heminephrectomy — Monitoring

Standard monitors, urinary catheter, and optional arterial line; follow electrolytes, ABG, hematocrit, and blood pressure when renal dysfunction is significant.

Pediatric Partial Nephrectomy or Heminephrectomy — Ventilation and physiology

Maintain pulmonary expansion in prone or flank position; moderate hyperventilation may lower potassium and increase pH during renal insufficiency.

Pediatric Partial Nephrectomy or Heminephrectomy — Regional options

Epidural or caudal analgesia requires normal coagulation; TAP, ilioinguinal, or iliohypogastric blocks avoid neuraxial urinary retention.

Pediatric Partial Nephrectomy or Heminephrectomy — Positioning risks

Brachial-plexus injury, eye injury, ETT movement, pressure injury, restricted pulmonary expansion, unstable table positioning, and obstructed urinary drainage.

Pediatric Partial Nephrectomy or Heminephrectomy — Major intraoperative risks

Hemorrhage, renal ischemia, injury to the remaining moiety or ureter, electrolyte disturbance, dysrhythmia, hypothermia, and positioning injury.

Pediatric Partial Nephrectomy or Heminephrectomy — Major postoperative risks

Bleeding under 5%, infection under 5%, ileus under 5%, hypovolemia, anemia, hypothermia, electrolyte abnormalities, coagulopathy, and metabolic or respiratory acidosis.

Pediatric Partial Nephrectomy or Heminephrectomy — Postoperative destination

PACU to ward; use PICU for major tumor surgery, renal failure, substantial blood loss, respiratory compromise, or hemodynamic instability.

Pediatric Partial Nephrectomy or Heminephrectomy — Critical communication

Confirm moiety function, preservation strategy, approach, vascular-control plan, ischemia time, blood readiness, stent or drain plan, and remaining-kidney function.

Pediatric Partial Nephrectomy or Heminephrectomy — Fast pearl

The priority is preserving the functioning renal moiety, not simply removing the diseased segment.