Anesthesia management of totally endoscopic atrial septal defect repair with a robotic surgical system

作者：Wang, Gang^*; Gao, Changqing; Zhou, Qi; Chen, Tingting; Wang, Yao; Wang, Jiali; Li, Jiachun

来源：Journal of Clinical Anesthesia, 2011, 23(8): 621-625.

DOI：10.1016/j.jclinane.2011.04.005

• Atrial septal defect repair
• Cardiac anesthesia
• da Vinci Surgical System
• Robotic surgery

Study Objective: To investigate anesthetic techniques for robot-assisted endoscopic atrial septal defect (ASD) repair.
Design: Clinical observational study.
Setting: Operating room of a general military hospital.
Patients: 56 adult, ASA physical status 1 and 2 patients undergoing elective general anesthesia.
Interventions: After induction of general anesthesia, a left-sided, double-lumen endotracheal tube was positioned to allow single left-lung ventilation and contralateral CO2 pneumothorax (capnothorax). With ultrasound guidance, peripheral cardiopulmonary bypass (CPB) catheters were placed.
Measurements and Main Results: All patients tolerated single left-lung ventilation before CPB; however, hypoxia (oxygen saturation <90%) occurred in 11 (19.6%) patients post-CPB, which required treatment with continuous positive airway pressure. Fifteen (26.8%) patients had hypotension secondary to capnothorax, which was treated with transfusion and vasopressors. Aortic cross-clamp time was 43.6 +/- 11.2 minutes, and CPB time was 106.7 +/- 12.4 minutes. The median intensive care unit stay was 21 hours and postoperative hospital stay was 4 to 7 days.
Conclusions: The key issue for anesthetic management of robot-assisted totally endoscopic ASD repair is maintaining stable hemodynamics and oxygenation, especially during one-lung ventilation and capnothorax.

• 出版日期2011-12
• 单位中国人民解放军总医院