Pediatric Nephroureterectomy Anesthesia - AnethAssist

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Pediatric Nephroureterectomy — What it is

Removal of a nonfunctioning renal moiety and ureter, with distal ureterectomy when necessary.

Pediatric Nephroureterectomy — Common indications

Nonfunctioning upper pole of a duplex system caused by ureterocele or ectopic ureter.

Pediatric Nephroureterectomy — Position

Supine or flank; prone-to-supine repositioning may be required.

Pediatric Nephroureterectomy — Surgical access

Dorsal lumbotomy or flank nephrectomy with ureteral dissection; distal ureterectomy may require a second Pfannenstiel incision.

Pediatric Nephroureterectomy — Typical duration

Approximately 3 h; repositioning may be required.

Pediatric Nephroureterectomy — Expected blood loss

Minimal.

Pediatric Nephroureterectomy — Pain and stimulation

Pain score 10.

Pediatric Nephroureterectomy — Anesthetic options

GETA with active warming and optional epidural when coagulation is normal; adjust anesthetic drugs and fluids for renal dysfunction.

Pediatric Nephroureterectomy — Airway

Secure the ETT and reconfirm depth, breath sounds, and circuit integrity after every turn or redrape.

Pediatric Nephroureterectomy — IV and blood preparation

One upper-extremity IV usually suffices; add access and blood readiness for renal dysfunction, difficult exposure, or unexpected hemorrhage.

Pediatric Nephroureterectomy — Monitoring

Standard monitors and urinary catheter; add arterial pressure, electrolytes, ABG, or hematocrit for renal failure or hemodynamic instability.

Pediatric Nephroureterectomy — Ventilation and physiology

Use controlled ventilation and reassess compliance, airway pressure, oxygenation, and venous return after each position change.

Pediatric Nephroureterectomy — Regional options

Epidural or caudal analgesia may reduce opioid use when coagulation is normal but can increase urinary retention.

Pediatric Nephroureterectomy — Positioning risks

ETT or line movement, brachial-plexus injury, eye injury when prone, pressure injury, impaired expansion, and repeated-positioning exposure.

Pediatric Nephroureterectomy — Major intraoperative risks

Hemorrhage, ureteral or vascular injury, positioning injury, hypothermia, dysrhythmia, electrolyte disturbance, and damage to the functioning renal moiety.

Pediatric Nephroureterectomy — Major postoperative risks

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

Pediatric Nephroureterectomy — Postoperative destination

PACU to ward; escalate for renal failure, significant blood loss, respiratory compromise, or hemodynamic instability.

Pediatric Nephroureterectomy — Critical communication

Confirm distal ureterectomy, second incision, repositioning sequence, reflux-dependent stump management, catheter or stent plan, renal function, and blood availability.

Pediatric Nephroureterectomy — Fast pearl

After every position change, repeat an airway, access, monitor, padding, and urinary-drainage checklist.