Investigation of anesthesia for robotic assisted coronary artery bypass grafting

Objective: Robotic assisted coronary artery bypass grafting（RACAB） surgery is a fast-developing technique with the use of the da Vinci surgical system.The anesthesia for RACAB was investigated which is technically more challenging.Methods: Between January 2007 and September 2007,16 RACAB surgeries on beating heart were performed at our institution with the da Vinci surgical system.With the standard general anesthesia,a double-lumen endotracheal tube was positioned to allow single right-lung ventilation.TEE,hemodynamics and blood gas were routinely monitored.Results: In 15 patients,left internal thoracic artery grafts were harvested with robotic assistance,and anastomoses were manually constructed through a small thoracotomy incision.In one other patient,totally endoscopic coronary artery bypass grafting（TECAB） was performed with the robotic system.Although single-lung ventilation and CO₂ pneumothorax were well tolerated in most patients,the sole patient to receive TECAB showed hypoxemia and hypercapnia,as well as a compensatory increase in heart rate.The period from completion of surgery to extubation averaged 4.72 hours.The average length of ICU stay was 1.2 days and post-operative hospital stay was 6.6 days.The complications included 1 patient with atrium fibrillation and 1 patient with atelectasis.Conclusion: The key point of anesthesia for RACAB is to deal with hypoxemia and undulated hemodynamics as a result of single right-lung ventilation and CO₂ pneumothorax.