Abstract
Robotic surgery is the future of minimally invasive surgery. Anaesthesiologists have to be prepared for the various challenges posed by robotic surgeries in terms of steep trendelenberg position, prolonged pneumoperitoneum and fluid restriction. Rheumatoid arthritis (RA) is a debilitating autoimmune inflammatory arthritis affecting almost every joint of the body. The various deformities due to RA can pose a challenge for proper positioning. It can also cause difficult venous cannulation, difficult airway, impaired respiratory function, multi-system involvement and propensity to cause neurovascular impingement. We present a case of severe rheumatoid arthritis with hypothyroidism posted for elective robotic radical hysterectomy and the anaesthetic challenges.
Highlights
Robotic surgery is a new feather in the revolutionary cap of minimally invasive surgery
Anaesthesiologists have to be prepared for the various challenges posed by different robotic surgeries in terms of steep trendelenberg position, prolonged pneumoperitoneum and fluid therapy
Case Report A 42 year old female patient with severe Rheumatoid arthritis (RA) was posted for robotic radical hysterectomy with bilateral salpingo-oopherectomy, pelvic lymph node dissection, omental biopsy and retroperitoneal node sampling for endometrial adenocarcinoma
Summary
Robotic surgery is a new feather in the revolutionary cap of minimally invasive surgery. Case Report A 42 year old female patient with severe RA (bed-ridden for the past 6 months) was posted for robotic radical hysterectomy with bilateral salpingo-oopherectomy, pelvic lymph node dissection, omental biopsy and retroperitoneal node sampling for endometrial adenocarcinoma She had typical dinner fork deformity of hands, fixed flexion deformity of elbows, hip and knee joints, with impossible shoulder or hip abduction. The patient was a known hypothyroid on thyroxine therapy Her investigations were within normal limits, including thyroid function tests. Analgesia was administered with intravenous paracetamol (1gm), port-site local anaesthetic infiltration and continuous intravenous fentanyl infusion (30- 40mcg/hr) She was shifted to the oncosurgical intensive care unit, put on pressure support ventilation initially, followed by CPAP (continuous positive airway pressure) mode and extubated over a tube exchanger device (due to known difficult airway) after 4 hours. The patient maintained all vital parameters and was later transferred to the ward
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