Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8656-8661
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8656
Anesthetics management of a renal angiomyolipoma using pulse pressure variation and non-invasive cardiac output monitoring: A case report
Woo Jae Jeon, Woo Jong Shin, Young Joon Yoon, Chan Woo Park, Jae Hang Shim, Sang Yun Cho
Woo Jae Jeon, Woo Jong Shin, Young Joon Yoon, Chan Woo Park, Jae Hang Shim, Sang Yun Cho, Department of Anesthesiolgy and Pain Medicine, Hanyang University Guri Hospital, Guri-si 471-701, Gyeonggi-do, South Korea
Author contributions: All authors including Jeon WJ, Shin WJ, Yoon YJ, Park CW, Shim JH and Cho SY participated in care of the patient, revised this manuscript, and have read and approved the final manuscript.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sang Yun Cho, MD, PhD, Professor, Department of Anesthesiolgy and Pain Medicine, Hanyang University Guri Hospital, No. 249-1 Gyomun-dong, Guri-si 471-701, Gyeonggi-do, South Korea. chosy@hanyang.ac.kr
Received: January 20, 2022
Peer-review started: January 20, 2022
First decision: May 11, 2022
Revised: May 23, 2022
Accepted: July 22, 2022
Article in press: July 22, 2022
Published online: August 26, 2022
Abstract
BACKGROUND

Hypovolemic shock can lead to life-threatening organ dysfunction, and adequate fluid administration is a fundamental therapy. Traditionally, parameters such as vital signs, central venous pressure, and urine output have been used to estimate intravascular volume. Recently, pulse pressure variation (PPV) and non-invasive cardiac monitoring devices have been introduced. In this case report, we introduce a patient with massive active bleeding from giant renal angiomyolipoma (AML). During emergent nephrectomy, we used non-invasive cardiac monitoring with CSN-1901 (Nihon Kohden, Tokyo, Japan) and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.

CASE SUMMARY

A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension. AML was diagnosed by computed tomography, and emergent nephrectomy was scheduled. Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring. During the surgery, 6000 mL of estimated blood loss occurred. Along with the patient's vital signs and laboratory results, we monitored cardiac output, cardiac output, stroke volume, stroke volume index with a non-invasive cardiac monitoring device, and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.

CONCLUSION

In addition to traditional parameters, non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provide guidance for intraoperative management of hypovolemic shock patients.

Keywords: Renal angiomyolipoma, Pulse pressure variation, Cardiac output, Case report

Core Tip: We present a giant ruptured renal angiomyolipoma (> 20 cm) with active bleeding. Emergent operation was performed. The successful fluid management was carried with pulse pressure variation and noninvasive cardiac output monitoring.