Management of anesthesia and cardiopulmonary bypass of pediatric abdominal tumor invading inferior vena caval and right atrium: our clinical experience

Abstract

AbstractObjectiveAbdominal tumor with inferior vena caval (IVC) and right atrium tumor thrombus is relatively rare in children. In this paper,we summarize the management of anesthesia and cardiopulmonary bypass(CPB) during the multidisciplinary treatment(MDT).MethodsWe retrospectively analyzed the clinical data of children with abdominal tumor with inferior vena caval and right atrium tumor thrombus from January 2012 to December 2022,who had been performed surgeon under CPB. We summarize the management of anesthesia and CPB, intraoperative hemorrhage ,arterial blood gas, blood transfusion, postoperative outcome,follow-up and so on.Results6 pediatric patients with IVC and right atrium tumor thrombus from abdominal tumor underwent surgical treatment with CPB. The primary malignancies were nephroblastom (n = 2), renal clear cell carcinoma(n = 1) and hepatoblastoma (n = 3). In all cases the primary tumor and tumor thrombus were completely removed. In all these patients, the mean age was 25.8 months (range 14-41months). The mean operative time was 459.8 min (range 365–580 min) and the mean anaesthesia time was 553.1 min (range 450–745 min). The mean cardiopulmonary bypass time was 150.3 min (range 91–261) .The mean cardiopulmonary bypass time was 150.3 min (range 91–261 min). The mean aortic block time was 46.1min (range 24–68 min) and the mean hypothermic circulatory arrest time was 22 min (range 3–46 min).The mean volume of red blood concentrates (RBC) transfuion was 5.1U(range 3-9.5U). There were all survival and no serious complications occurred after operation untill December 2022 for the follow-up.ConclusionsPediatric abdominal tumor with IVC and right atrium tumor thrombus is relatively rare, and the management of anesthesia and CPB for this multidisciplinary surgical treatment have not been reported.Thus, our report provides clinical experience of the management of anesthesia and CPB. Induction of anesthesia steadily and intraoperative massive hemorrhage are the major challenges during anesthetic management, as well as the management of intraoperative critical situations.