Anesthesia for endoscopic robotic coronary artery bypass grafting on beating heart

Abstract

Objective Anesthesia for endoscopic robotic coronary artery bypass grafting surgery on beating heart to deal with the hemodynamic compromise, hypoxia and hypercarbia relevant to one lung ventilation ( OLV ) and intrathoracic inflation of CO2 with positive pressure (CO2 pneumothorax) is crucial. Methods Between February 2007 and January 2011, 163 patients underwent robotically assisted coronary artery bypass surgery on beating heart using the da Vinci S Surgical System. Of them, 62 patients underwent totally endoscopic coronary artery bypass grafting ( TECAB). Other 101 patients underwent robotically assisted endoscopic atraumatic coronary artery bypass ( ENDOACAB) in which the left internal mammary artery was harvested robotically and direct anastomosis via a small left anterior thoractomy incision. Results PaO2 and SvO2 after initiate of OLV and CO2 pneumothorax showed a significant decrease. Meanwhile, the SpO2 decreased to 0.92 in 17 of the 163 patients.In these patients, application of CPAP setting 5-15 cmH2O to the collapsed lung resulted in an increase in PaO2 from (59 ±12) mmHg to (115 ±23) mmHg (P < 0.05). At the beginning of CO2 pneumothorax the most dramatic fall in MAP and CI was showed with an increase in MPAP and HR. The hemodynamie compromise was counteracted by transfusion and inotropes/ vasopressors. Postoperatively, the average extubation time was (7. 5 ±3. 1) hours, and median ICU length of stay was 21 hours. One patient remained in the ICU for 3 days for treatment of a postoperative pneumonia. One patient who had underwent ENDOACAB were reexplored for bleeding in the left anterior thoracotomy incision. All patients were discharged home 4 to 7 days after surgery. Conclusion Anesthetic management for the procedures requires detailed knowledge of OLV and CO2 pneumothorax in addition to expertise required in conventional cardiac surgery. Key words: Coronary artery bypass; Anesthesia; Robotic