title: Myocardial infarction and subsequent death in a patient undergoing robotic prostatectomy.
abstract: A 52-year-old patient, ASA physical status IV, undergoing a radical prostatectomy for cancer with a robotic system had a cardiac arrest 3 hours into the case. All attempts to resuscitate were unsuccessful, and several hours later he was pronounced dead. Underlying patient comorbidity and procedural issues contributed to the patient's death. The patient had a history of coronary artery disease that required the placement of drug-eluting stents 2 years before this surgical procedure. The preoperative cardiac evaluation and pharmacological management of patients with drug-eluting coronary stents are reviewed. There are a number of positional and technical considerations for patients undergoing robotic surgical procedures, especially in relation to the requirement of low-lithotomy and steep Trendelenburg positions. The cardiac and respiratory systems are especially vulnerable to the extreme and lengthy head-down position. The needed positioning, combined with the problems associated with insufflation, presents a unique challenge in anesthetic management. This course reviews the current literature on the surgical implications for patients with drug-eluting stents and the physiologic factors related to position and pneumoperitoneum and their associated stressors. By using a review of the contemporary literature, a best-evidence approach to anesthetic management is reviewed.
authors.affiliation: Hospital of St Raphael, School of Nurse Anesthesia, New Haven, Connecticut, USA. judy6270@yahoo.com
authors.forename: Judy
authors.initials: J
authors.lastname: Thompson
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D055317:Evidence-Based Practice; D017809:Fatal Outcome; D018475:Head-Down Tilt / Q000009:adverse effects*; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D009719:Nurse Anesthetists; D009730:Nursing Assessment; D019990:Perioperative Care / Q000379:methods / Q000451:nursing; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000451:nursing; D011468:Prostatectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000451:nursing; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery; D012307:Risk Factors; D012371:Robotics / Q000295:instrumentation / Q000379:methods