Anesthesia for robotic heart surgery: an overview.

Abstract

An innovative approach to coronary revascularization, robotically-assisted vision-enhanced coronary artery bypass (RAVECAB), is performed by means of a small anterior minithoracotomy or ministernotomy on a beating heart without the aid of cardiopulmonary bypass. Components of this technique include thoracoscopic video-assisted harvesting of the internal mammary artery (IMA), robotic telemanipulation, and prolonged one-lung ventilation (OLV). With the absence of cardioplegia, myocardial protection during normothermic beating heart surgery poses a challenge. Patient selection is important to avoid intraoperative and postoperative complications. Prolonged onelung ventilation, incomplete revascularization in hybrid procedures, and limited access for rapid intervention pose challenges for patient management. Conversion to sternotomy may be required in 3-5% of patients, and extension of portals over several dermatomal segments requires a versatile analgesic technique. The use of regional anesthesia as general anesthesia adjuvant allows lighter levels of general anesthesia during surgery, with minimal intraoperative hemodynamic changes and a smooth transition to postoperative analgesia. Although a number of regional techniques may be used to achieve this goal, continuous percutaneous paravertebral block (PVB) offers specific, potent analgesia and advantages associated with cardiac sympathectomy.