Anesthetic Management in Post-Chemotherapy Retroperitoneal Lymph Node Dissection: Insights from Our Clinical Experience

Authors : Nadide Örs Yıldırım, Hilal Zengin

Pages : 117-123

Doi:10.53394/akd.1531738

View : 30 | Download : 51

Publication Date : 2025-01-24

Article Type : Research Paper

Abstract :Objective: Testicular tumors, of which 95% are germ cell tumors, are generally solid tumors seen in men under the age of 35. Testicular tumors are primarily treated with orchiectomy. Following orchiectomy and chemotherapy, retroperitoneal lymph node dissection (RPLND) is an important surgical procedure in uro-oncology. In our study, we aimed to share our experiences by discussing our anesthesia management in RPLND operations conducted after chemotherapy at our hospital in light of current literature. Material and Methods: This study investigates cases of Retroperitoneal Lymph Node Dissection (RPLND) performed after chemotherapy at a tertiary education and research hospital between 2017 and 2023. After obtaining approval from the Ethics Committee (No: 2023/305), data including patients\\\' ages, operation durations, perioperative blood gas and fraction of inspired oxygen (FiO₂) values, and the amount of fluid administered during the procedure were retrospectively reviewed from patient records and anesthesia monitoring forms. Patients with incomplete information were excluded from the study. Blood gas samples obtained immediately after anesthesia induction were compared with those taken upon admission to the intensive care unit. In our clinic, routine consultations with chest diseases and medical oncology are obtained prior to this procedure. Results: In our study, data from 34 out of 37 RPLND cases conducted over a four-year period were included. ASA III patients constituted 35% (n=12), while ASA II patients made up 65% (n=22), with an average age of 28 years (range: 17 to 47).The average anesthesia duration from the time patients entered the operating room to their admission to the ICU was recorded as 340.7 minutes, and the average extubation time from ICU admission was 125.6 minutes. While there were no significant changes in the average pH, pO₂, and pCO₂ values in blood gases of patients a significant increase in lactate levels was observed. It was noted that the perioperative (FiO₂) was maintained below 40% and the crystalloids administered in the first 2 hours were kept below 4 mL/kg/hour. All patients were discharged home after the operation. Conclusion: RPLND requires a multidisciplinary approach. Measures taken against perioperative hypoxia and hyperoxia, as well as fluid management, may be crucial in preventing major complications that can arise during both the intraoperative and postoperative periods.
Keywords : Germ hücre tümörü, Hiperoksi, Multidisipliner yaklaşım, Pulmoner toksisite, Retroperitoneal lenf nodu diseksiyonu