Robotic Nephrectomy in a Patient With a Single Kidney: An Approach Ensuring Safety and Success

Perioperative anesthetic management for radical nephrectomy in a previous post-nephrectomy patient poses various challenges and requires thorough clinical and radiological evaluation. A comprehensive plan, including point-of-care intensive monitoring to prevent major fluid shifts, acidemia, and maintain electrolyte homeostasis, as well as robot-assisted surgery, is essential for achieving optimal surgical outcomes. In this case report, we describe the perioperative management of a 70-year-old male patient, a postoperative case of right radical nephrectomy, who was scheduled for left robotic nephrectomy. Maintaining a mean arterial pressure (MAP) above 65 mmHg, achieving an euvolemic state, and preventing acidosis, hyperkalemia, and hypernatremia were our primary targets; however, achieving these goals proved quite challenging. Serial arterial blood gas (ABG) analysis, ultrasound-guided B-line scoring, advanced cardiac monitoring, and an appropriate combination of anesthetic agents with minimal renal excretion and a short duration of action facilitated the successful management of the patient.