ANESTHESIA MANAGEMENT IN RADICAL CYSTECTOMY: A CASE REPORT

I Gusti Agung Bagus Wisma Parikrama; Iswahyudi

ANESTHESIA MANAGEMENT IN RADICAL CYSTECTOMY: A CASE REPORT

Authors

I Gusti Agung Bagus Wisma Parikrama General Practitioner, Bali Mandara Hospital, Denpasar, Bali, Indonesia
Iswahyudi Department of Anesthesiology and Intensive Therapy, Bali Mandara Regional General Hospital

Keywords:

chronic kidney disease, general anesthesia, perioperative management, radical cystectomy

Abstract

Background: Radical cystectomy is a urological surgical procedure with a high risk of perioperative complications, especially in patients with multiple comorbidities such as chronic kidney disease (CKD) undergoing hemodialysis. Fluid and electrolyte imbalances, anemia, and hemodynamic instability are the main challenges in anesthesia management in this patient group. This case report aims to highlight the specific challenges related to anesthesia and perioperative management during radical cystectomy in high-risk patients.

Case Presentation: A 67-year-old male was diagnosed with bladder stones with suspected bladder tumor, benign prostatic hyperplasia, complicated urinary tract infection, bilateral hydronephrosis with right nephrostomy, left kidney stone, type 2 diabetes mellitus, and CKD on hemodialysis. Laboratory examination showed anemia, leukocytosis, elevated blood urea nitrogen and creatinine, and hyperkalemia. The patient underwent radical cystectomy under general anesthesia using fentanyl, propofol, and atracurium as induction agents, and sevoflurane in an N₂O-O₂ mixture for anesthesia maintenance. The surgery lasted approximately 6 hours with administration of crystalloids, packed red cell transfusion, and albumin. Intraoperatively, the patient experienced hypotension down to 80/50 mmHg requiring vasopressors and inotropics. Postoperatively, the patient was successfully extubated in stable condition and admitted to the intensive care unit for further observation.

Conclusion: Anesthesia management in radical cystectomy for CKD patients on hemodialysis requires a comprehensive perioperative approach, including appropriate selection of anesthetic agents, careful fluid management, and strict hemodynamic monitoring to support optimal postoperative outcomes.

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ANESTHESIA MANAGEMENT IN RADICAL CYSTECTOMY: A CASE REPORT