ROBOTIC ASSISTED MINIMALLY INVASIVE CARDIAC SURGERY DA VINCI ROBOTIC SYSTEM. ANALYSIS OF PERIOPERATIVE CONSIDERATIONS

Abstract

<h3>Introduction</h3> Robotic assisted minimally invasive cardiac surgery is a complex procedure where the anesthesiologist works in situations that require management skills. <h3>Method</h3> The study design is a retrospective observational model, which was performed with chart review. Data were collected from 104 patients who underwent minimally invasive cardiac surgery and were repaired using the Da Vinci robot-assisted minimally invasive approach from November 2019 to March 2022. The variables collected were assigned into three groups: preoperative variables, intraoperative variables and postoperative variables. The preparatory variables were age, sex, personal history of interest, Anesthetic Risk Scale (ASA), European System for Cardiac Operation Risk Evaluation II (EUROESCORE II), preoperative echocardiography, preoperative laboratory tests and diagnosis. Intraoperative variables were type of anesthesia, airway device used, invasive monitor, intraoperative transesophageal echocardiography data, complications, vasoactive drug use, blood product transfusion, extracorporeal circulation times and aortic clamping times, analgesic technique, extubation and surgical outcome. Finally, the postoperative variables were length of stay in the intensive care unit, length of hospital stay and postoperative complications. <h3>Results</h3> On the ASA 101 patients (97.1%) were in the ASA IV group and only 3 patients were in the ASA V group (2.9%). In the Euroescore II 103 patients scored less than 3 (99.03 %) and only one patient scored above 3 (0.9 %). Regarding anesthesia, 71 patients received total intravenous general anesthesia (68,3%) and 32 patients received balanced general anesthesia (30,7%) and in 1 patient this information could not be collected (0,9%)).. For airway management, a left double-lumen tube was used in 21 patients (20.8%), a Vivasight-type camera tube in 47 patients (46.6%) and a bronchial blocker through a conventional tube under fibrobronchoscopic vision in 33 patients (32.6%). In 3 patients this information could not be collected. Only 1 patient suffered serious complications during surgery (0.96 %). Vasoactive drugs were used in 81 patients (78%). Blood products were transfused in 7 patients (6.7%). The analgesic technique used consisted of locoregional blocks in 59 patients (56%), Locoregional block + patient-controlled morphine analgesia (PCA) in 14 patients (13,4%), PCA only in 29 patients (27,8%) and in 4 patients we do not know this information (3,8%). With regard to postoperative complications, 26 patients (25 %) were recorded. One patient died (0.96%). <h3>Conclusions</h3> In minimally invasive robotic-assisted cardiac surgery there are fundamental details to consider before, during and post-intervention such as the selection of the right patient, preoperative assessment, anesthetic technique, airway management, performing a good transesophageal echocardiographic study, hemodynamic behavior of the patient during the intervention, measures to take in case of complications and postoperative management, among others. Little literature exists so far and more studies are needed. ANALYSIS OF ANAESTHETIC CONSIDERATIONS