Renal Cell Carcinoma in Pregnancy: Radical Nephrectomy and the Use of Dexmedetomidine

Renal cell carcinoma is sinister cancer, uncommon during pregnancy. A 26-week period of gestation, primigravida pregnant women presented with painless hematuria and left flank fullness. She was found to have left-sided renal cell carcinoma, with no metastasis or vascular invasion. All her preoperative investigations were within normal limits, except for mild anemia. An obstetric evaluation was unremarkable, with normal fetal heart sounds. Perioperative care of pregnant patients for oncosurgery poses great challenges, affecting both the mother and the fetus. Preoperative tocolytic therapy was started to prevent preterm labor, and an obstetrician was kept standby during surgery. A combined general anesthesia with rapid sequence induction and cricoid pressure along with preinduction epidural catheter was administered, followed by the insertion of invasive monitoring lines. Dexmedetomidine use is also highlighted, as it has several beneficial effects and has been safely used in pregnant patients. The tumor was successfully removed, and the patient was transferred to the high-dependency-care unit after extubation. We hereby describe the perioperative anesthetic challenges in this unique case report.