Anaesthetic Management of a 75-Year-Old Male with Multiple Comorbidities and Adrenal Adenoma Undergoing Robotic Nephrectomy: A Case Report

Elderly patients with multiple associated comorbidities undergoing urological surgery present significant pre-operative challenges in anaesthetic management. The case discussed in this report involves a 75-year-old male with hypertension, bronchial asthma, and a history of stroke, who was diagnosed with a left renal mass and a right adrenal adenoma. Pre-operative assessment revealed high blood pressure, left-sided weakness, and multiple respiratory and cardiovascular abnormalities. Combined general and epidural anaesthesia was administered to the patient. Intraoperatively, significant haemodynamic fluctuations were observed during the manipulation of the tumour, which were successfully managed with vasoactive medications and epidural analgesia. Postoperatively, the patient was transferred to the surgical intensive care unit for monitoring and had an uneventful recovery. This case report focusses on pre-operative evaluation, intraoperative monitoring, and the use of multimodal anaesthesia in high-risk elderly patients. The haemodynamic instability during tumour manipulation indicated the presence of a catecholamine-secreting tumour, making it crucial to monitor vital signs and intervene promptly. Successful anaesthetic management requires thorough preparation and individualised anaesthetic planning for elderly patients undergoing robotic nephrectomy. Combined general and epidural anaesthesia provides effective pain management and haemodynamic stability.