ANAESTHETIC MANAGEMENT IN PATIENT OF RENAL CELL CARCINOMA UNDERGOING ROBOTIC RADICAL NEPHRECTOMY WITH INFERIOR VENA CAVA TUMOUR THROMBECTOMY.

Renal cell carcinoma has vascular invasion and extend into IVC and even into the right-sidedcardiac chambers.Nephrectomy with thrombectomy provide palliation of symptoms with 5-year survival rate of 72% inabsence of distant metastasis.AIMS AND OBJECTIVES:Anaesthetic management varies based on extension of tumour and is challenging due to IVCclamping,hemodynamic instability,potential for massive haemorrhage,and risk of intra operative tumour embolization.METHODOLOGY: A 62-year-old male hypertensive with COPD patient presented with pain in right lower back andhaematuria. He was evaluated with USG abdomen, CT abdomen, confirming right RCC with thrombus extending intoright renal vein and infradiaphragmatic IVC. The patient was planned for right radical nephrectomy with IVCthrombectomy.RESULT: The intra operative course was hemodynamically stable, except when the IVC was clamped duringthrombectomy. Hypotension was managed with injection noradrenaline 0.03–0.05mcg/kg/min. Patient was extubatednext morning as he was hemodynamically stableCONCLUSION: Successful anaesthetic management of RCC with IVC thrombus requires meticulous monitoring.Central venous pressure and hourly urine output monitoring can be used to achieve desired hemodynamic goals.