Anesthetic Issues for Robotic Cardiac Surgery

Overview

Journal Ann Card Anaesth

Specialty Anesthesiology

Date 2015 Jan 9

PMID 25566713

Citations 4

Authors

Wendy K Bernstein

Andrew Walker

Affiliations

Soon will be listed here.

Abstract

As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE). This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one-lung ventilation (OLV) including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure.

Citing Articles

Robot-assisted coronary artery bypass surgery: a systematic review and meta-analysis of comparative studies.

Hammal F, Nagase F, Menon D, Ali I, Nagendran J, Stafinski T Can J Surg. 2020; 63(6):E491-E508.

PMID: 33155975 PMC: 7747852.

Cardiothoracic robotic assisted surgery in times of COVID-19.

Van den Eynde J, De Groote S, Van Lerberghe R, Van den Eynde R, Oosterlinck W J Robot Surg. 2020; 14(5):795-797.

PMID: 32385799 PMC: 7207081. DOI: 10.1007/s11701-020-01090-7.

Medical robots in cardiac surgery - application and perspectives.

Kroczek K, Kroczek P, Nawrat Z Kardiochir Torakochirurgia Pol. 2017; 14(1):79-83.

PMID: 28515758 PMC: 5404137. DOI: 10.5114/kitp.2017.66939.

Anesthetic considerations in robotic mitral valve surgery.

Rehfeldt K, Andre J, Ritter M Ann Cardiothorac Surg. 2017; 6(1):47-53.

PMID: 28203541 PMC: 5293623. DOI: 10.21037/acs.2017.01.10.

References

Mierdl S, Byhahn C, Lischke V, Aybek T, Wimmer-Greinecker G, Dogan S . Segmental myocardial wall motion during minimally invasive coronary artery bypass grafting using open and endoscopic surgical techniques. Anesth Analg. 2005; 100(2):306-314. DOI: 10.1213/01.ANE.0000143565.18784.54. View

Liu T, Shih M, Lee W, Wang K, Liu C, Hung C . Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery. Ann Thorac Surg. 2013; 96(1):127-32. DOI: 10.1016/j.athoracsur.2013.04.017. View

Reichenspurner H, Gulielmos V, Wunderlich J, Dangel M, Wagner F, Pompili M . Port-Access coronary artery bypass grafting with the use of cardiopulmonary bypass and cardioplegic arrest. Ann Thorac Surg. 1998; 65(2):413-9. DOI: 10.1016/s0003-4975(97)01154-5. View

Dhole S, Mehta Y, Saxena H, Juneja R, Trehan N . Comparison of continuous thoracic epidural and paravertebral blocks for postoperative analgesia after minimally invasive direct coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2001; 15(3):288-92. DOI: 10.1053/jcan.2001.23271. View

Woo Y, Nacke E . Robotic minimally invasive mitral valve reconstruction yields less blood product transfusion and shorter length of stay. Surgery. 2006; 140(2):263-7. DOI: 10.1016/j.surg.2006.05.003. View

Chauhan S, Sukesan S . Anesthesia for robotic cardiac surgery: an amalgam of technology and skill. Ann Card Anaesth. 2010; 13(2):169-75. DOI: 10.4103/0971-9784.62947. View

Ohtsuka T, Imanaka K, Endoh M, Kohno T, Nakajima J, Kotsuka Y . Hemodynamic effects of carbon dioxide insufflation under single-lung ventilation during thoracoscopy. Ann Thorac Surg. 1999; 68(1):29-32; discussion 32-3. DOI: 10.1016/s0003-4975(99)00319-7. View

Bonaros N, Schachner T, Wiedemann D, Oehlinger A, Ruetzler E, Feuchtner G . Quality of life improvement after robotically assisted coronary artery bypass grafting. Cardiology. 2009; 114(1):59-66. DOI: 10.1159/000212115. View

Iribarne A, Easterwood R, Chan E, Yang J, Soni L, Russo M . The golden age of minimally invasive cardiothoracic surgery: current and future perspectives. Future Cardiol. 2011; 7(3):333-46. PMC: 3134935. DOI: 10.2217/fca.11.23. View

10.

Bucerius J, Metz S, Walther T, Falk V, Doll N, Noack F . Endoscopic internal thoracic artery dissection leads to significant reduction of pain after minimally invasive direct coronary artery bypass graft surgery. Ann Thorac Surg. 2002; 73(4):1180-4. DOI: 10.1016/s0003-4975(02)03385-4. View

11.

Murkin J, Ganapathy S . Anesthesia for robotic heart surgery: an overview. Heart Surg Forum. 2002; 4(4):311-4. View

12.

Puskas J, Sadiq A, Vassiliades T, Kilgo P, Lattouf O . Bilateral internal thoracic artery grafting is associated with significantly improved long-term survival, even among diabetic patients. Ann Thorac Surg. 2012; 94(3):710-5. DOI: 10.1016/j.athoracsur.2012.03.082. View

13.

Athanasiou T, Ashrafian H, Rowland S, Casula R . Robotic cardiac surgery: advanced minimally invasive technology hindered by barriers to adoption. Future Cardiol. 2011; 7(4):511-22. DOI: 10.2217/fca.11.40. View

14.

Denault A, Deschamps A, Murkin J . A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth. 2008; 11(4):274-81. DOI: 10.1177/1089253207311685. View

15.

Walther T, Falk V, Metz S, Diegeler A, Battellini R, Autschbach R . Pain and quality of life after minimally invasive versus conventional cardiac surgery. Ann Thorac Surg. 1999; 67(6):1643-7. DOI: 10.1016/s0003-4975(99)00284-2. View

16.

Tatoulis J . Total arterial coronary revascularization-patient selection, stenoses, conduits, targets. Ann Cardiothorac Surg. 2013; 2(4):499-506. PMC: 3741872. DOI: 10.3978/j.issn.2225-319X.2013.07.02. View

17.

Suematsu Y, Kiaii B, Bainbridge D, Del Nido P, Novick R . Robotic-assisted closure of atrial septal defect under real-time three-dimensional echo guide: in vitro study. Eur J Cardiothorac Surg. 2007; 32(4):573-6. DOI: 10.1016/j.ejcts.2007.06.026. View

18.

Byhahn C, Mierdl S, Meininger D, Wimmer-Greinecker G, Matheis G, Westphal K . Hemodynamics and gas exchange during carbon dioxide insufflation for totally endoscopic coronary artery bypass grafting. Ann Thorac Surg. 2001; 71(5):1496-501; discussion 1501-2. DOI: 10.1016/s0003-4975(01)02428-6. View

19.

Rehman A, Garcia J, Deshpande S, Fitzpatrick M, Odonkor P, Zimrin D . Poor left ventricular function is not a contraindication for robotic totally endoscopic coronary artery bypass grafting. Heart Surg Forum. 2009; 12(3):E152-4. DOI: 10.1532/HSF98.20091048. View

20.

Bonatti J, Garcia J, Rehman A, Odonkor P, Haque R, Zimrin D . On-pump beating-heart with axillary artery perfusion: a solution for robotic totally endoscopic coronary artery bypass grafting?. Heart Surg Forum. 2009; 12(3):E131-3. DOI: 10.1532/HSF98.20091036. View