Successful Anaesthetic Management of a Case of Open Nephrectomy for Grade 5 Renal Injury

Abstract

Blunt trauma to the abdomen can cause damage to vital organs like spleen, liver, kidney and intestines and is associated with high morbidity. Hereby we are presenting a case of Grade 5 Renal Injury(shattered kidney) following blunt injury abdomen. A 21 year old male presented to our Emergency Room with history of RTA. He revealed history of severe abdominal pain. He presented with severe tachycardia (HR−140⁄minute),blood pressure and saturation were normal and GCS was 15⁄15. His CECT abdomen revealed shattered left kidney with subcapsular and perinephric collection with renal vascular injury. His hemoglobin was found to be 5.7g/dl, rest of the blood investigations were within normal limits. He was shifted to OT immediately and was proceeded with open nephrectomy. Post induction he devoloped severe hypotension and was started on iv crystalloids and colloids and minimal Nor adrenaline support. Intraoperatively 4 units of PRBC and 3 units of FFP were transfused. Around 1 litre of blood, bladder clots and a concealed hematoma in messentry were evacuated. Post transfusion ABG revealed metabolic acidosis. He was shifted to ICU with the ET Tube. He made an uneventful recovery in ICU and was extubated.Physiologically, hemodynamic compensatory mechanisms maintain vital organ perfusion till about 30% TBV loss, beyond which there is a risk of critical hypoperfusion. Massive blood loss is best managed by following the massive transfusion protocol (MTP).