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

Abstract

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 CO 2 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.