Pediatric Nephrectomy Anesthesia - AnethAssist

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Pediatric Nephrectomy — What it is

Removal of a poorly functioning or nonfunctioning pediatric kidney through flank, dorsal lumbotomy, abdominal, laparoscopic, or robotic exposure.

Pediatric Nephrectomy — Common indications

Congenital dysplasia, end-stage reflux nephropathy, ureteropelvic-junction obstruction, or symptomatic or enlarging multicystic dysplastic kidney.

Pediatric Nephrectomy — Position

Flank, prone, or lateral; some abdominal or laparoscopic approaches are supine.

Pediatric Nephrectomy — Surgical access

Subcostal flank, dorsal lumbotomy, open abdominal, laparoscopic, or robotic exposure; retroperitoneal dissection ligates the ureter and renal vessels.

Pediatric Nephrectomy — Typical duration

Approximately 2.5 h.

Pediatric Nephrectomy — Expected blood loss

Usually minimal.

Pediatric Nephrectomy — Pain and stimulation

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

Pediatric Nephrectomy — Anesthetic options

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

Pediatric Nephrectomy — Airway

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

Pediatric Nephrectomy — IV and blood preparation

Use one upper-extremity IV; add access and blood when needed. Protect AV fistulas and avoid potassium-containing fluid in oliguric renal failure.

Pediatric Nephrectomy — Monitoring

Standard monitors and urinary catheter; add arterial pressure, serial electrolytes, and ABGs for renal failure, hypertension, or major hemodynamic variability.

Pediatric Nephrectomy — Ventilation and physiology

Maintain full pulmonary expansion in prone or lumbodorsal position; moderate hyperventilation may lower potassium and raise pH during renal insufficiency.

Pediatric Nephrectomy — Regional options

Epidural is appropriate only with normal coagulation; TAP, ilioinguinal, iliohypogastric, or caudal techniques may reduce systemic opioid requirements.

Pediatric Nephrectomy — Positioning risks

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

Pediatric Nephrectomy — Major intraoperative risks

Peripheral-nerve injury, eye trauma, hemorrhage, dysrhythmia, electrolyte disturbance, hypothermia, pleural injury, and indigo-carmine-related hypertension, hypotension, bradycardia, or bronchospasm.

Pediatric Nephrectomy — Major postoperative risks

Hypovolemia, anemia, hypothermia, electrolyte abnormalities, coagulopathy, and metabolic or respiratory acidosis.

Pediatric Nephrectomy — Postoperative destination

PACU followed by ward or PICU according to renal failure, blood loss, age, respiratory status, and hemodynamic stability.

Pediatric Nephrectomy — Critical communication

Confirm approach and position, renal function, dialysis timing, AV-access protection, potassium, fluid limit, epidural suitability, blood availability, and remaining-kidney function.

Pediatric Nephrectomy — Fast pearl

Never place a blood-pressure cuff or IV on an AV-fistula arm, and avoid potassium-containing crystalloid in oliguric ESRD.