Management of Anaesthesia and Cardiopulmonary Bypass in Paediatric Patients With Abdominal Tumours Invading the Inferior Vena Cava and Right Atrium: A Case Series of a Tertiary Children's Medical Centre in China

TL;DR

This paper presents a case series on managing anesthesia and surgery for rare pediatric abdominal tumors invading the inferior vena cava and right atrium.

Contribution

The study provides a detailed retrospective analysis of anesthesia and cardiopulmonary bypass strategies in a rare pediatric surgical condition.

Findings

Six pediatric patients underwent successful tumor thrombus removal via CPB with no serious complications.

Average CPB time was 150.3 minutes, and average ICU stay was 6.2 days post-surgery.

Steady anesthesia induction and managing intraoperative massive hemorrhage were key challenges.

Abstract

Paediatric patients with abdominal tumours associated with tumour thrombus in the inferior vena cava (IVC) and right atrium are relatively rare in clinical practice. Hence, we summarised the management strategies for anaesthesia and cardiopulmonary bypass (CPB) used during surgical treatment for these conditions through multidisciplinary cooperation.

We collected the clinical data of paediatric patients who underwent surgery for tumour thrombus removal via CPB from January 2012 to December 2022 because their abdominal tumours had invaded the IVC and right atrium. We explored the strategies used to manage anaesthesia and CPB, assessed the incidence of intraoperative haemorrhage and arterial blood gas analysis, reported the incidence of blood transfusion and described the postoperative outcome and follow‐up.

A total of six paediatric patients underwent surgery under CPB to remove the tumour thrombus. Among them, two patients had nephroblastoma, one had renal clear cell carcinoma and three had hepatoblastoma. The average age of the six patients was 25.8 months. The average operation time was 459.8 min, and the average anaesthesia time was 553.1 min. The average CPB time was 150.3 min, and the average aortic block time was 46.1 min. The average hypothermic circulatory arrest time was 20 min. The average quantity infused was as follows: red blood concentrate (RBC): 5.1 units, cryoprecipitate: 3.2 units, fresh frozen plasma (FFP): 200 mL and platelets (PLTs): 4.2 units. The time of extubation ranged from 4 h to 8 days, and the average time spent in the intensive care unit (ICU) was 6.2 days after surgery. No serious complications occurred during the follow‐up period.

The present retrospective study aims to share our clinical experience with the management strategies of anaesthesia and CPB. Steady induction of anaesthesia, intraoperative massive haemorrhage and critical intraoperative situations are the major challenges in anaesthesia management.

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