Multidisciplinary management of a Jehovah's Witness patient for the removal of a renal cell carcinoma extending into the right atrium

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
David M MoskowitzM Arisan Ergin

Abstract

To highlight the management of a Jehovah's witness surgical patient presenting for cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest. A 47-yr-old male, Jehovah's Witness, with renal cell carcinoma was admitted for left radical nephrectomy and excision of tumour thrombus extending into the junction of the inferior vena cava (IVC) and right atrium (RA). The preoperative goals were to maximize red blood cell mass, delineate the extent of tumour extension and develop a surgical plan incorporating blood conservation strategies to minimize blood loss. A midline abdominal incision was made to optimize removal of the non-caval portion of the tumour from the intra-abdominal region. CPB and deep hypothermic circulatory arrest were instituted to aid in removing the tumour from the IVC and RA. Intraoperative blood conservation strategies included the use of acute normovolemic hemodilution, antifibrinolytics, cell salvage, point-of-care monitoring of heparin and protamine blood concentrations, leukocyte-depleting filter, and meticulous surgical techniques. The patient was successfully weaned from CPB and was transported to the cardiothoracic intensive care unit without complication. The patient was discharged home one wee...Continue Reading

References

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Citations

Aug 5, 2008·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Ashraf Fayad
Sep 12, 2003·Journal of Cardiothoracic and Vascular Anesthesia·Paul G LoubserJohn H Lemmer
Aug 31, 2010·British Journal of Anaesthesia·A Ashworth, A A Klein
Jun 13, 2006·Transfusion Medicine·R D SlightP S Mankad
Apr 7, 2004·Transfusion Medicine Reviews·Zenon M BodnarukMervyn J Thomas
May 12, 2004·Critical Care Clinics·Aryeh Shander
Mar 24, 2016·Transfusion·Aryeh ShanderHans Gombotz
Jan 15, 2005·Anaesthesia and Intensive Care·G MacLaren, M Anderson
Nov 21, 2019·International Urology and Nephrology·Ashraf SelimJames E Lingeman
Jul 5, 2008·American Journal of Otolaryngology·Olubukola A AdelolaJohn E Fenton

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