Anesthetic management of a hemodialysis-dependent patient for the brain tumor resection with CHDF

A 64-year-old man was scheduled for resection of brain tumor in the prone position. He had been on hemodialysis for three years. Anesthesia was induced using propofol, fentanyl, and vecuronium, and maintained with isoflurane and nitrous oxide in oxygen. Transesophagial echocardiography (TEE) was useful for maintaining fluid balance. To prevent bleeding tendency and to maintain electrolyte balance, continuous hemodiafiltration (CHDF) without anti-coagulant drugs was utilized for fluid management. Surgery was performed in the lateral position since the application of CHDF was impossible in the prone position. Approximately 3500 ml of blood was lost and 18 units of packed blood cells and 18 units of flesh frozen plasma were administered. We occasionally checked activated clotting time and platelet count during surgery, but they were kept in normal ranges. In this case, we were able to achieve proper intraoperative fluid management using TEE and CHDF.