Anesthetic management in children with giant nephroblastoma. Presentation of a case

Abstract

Introduction: Nephroblastoma is the most common abdominal solid tumor in childhood. The first description of this type of tumor was due to Hunter in 1793. In 1899, Max Wilms (1867– 1918), also a surgeon, described a tumor that he called nephroblastoma, which later became known as Wilms tumor. It occurs most frequently in the first five years of life. Objective: Present the anesthetic management during surgery in a child with giant nephroblastoma. Clinical case: Two-year-old male patient, weighing 10 kg, who began with abdominal pain three months before admission. Deep palpation on the right flank revealed a non-mobile, painful mass of hard consistency, approximately 25 cm in diameter, with regular outlines and smooth surface. Laboratory tests showed lymphopenia, mild eosinophilia and iron deficiency anemia in the hemogram. Abdominal ultrasound showed a round, solid-looking image that measures approximately 30cm in diameter at the lower pole of the right kidney. The anesthetic plan for the laparotomy consisted of multimodal anesthesia. Prolonged surgery requires vigorous intravascular volume replacement with crystalloids, colloids, and blood. Right nephrectomy resecting a 3.7 kg giant mass was achieved. The patient presented several postoperative complications, including hemodynamic instability, oliguria, hypoglycemia, seizures, and hypoproteinemia. The strict follow-up and timely treatment of each complication allowed the patient to be discharged on the eighth postoperative day. Conclusions. The anesthetic management of this type of patient is a challenge, especially in poor working conditions, lacking both equipment and medicines in this country; however, multimodal anesthesia technique is effective and safe for achieving success.