[Anesthesic management in telerobotic totally endoscopic coronary artery bypass grafting].
OBJECTIVE
To investigate the strategies for anesthetic management for totally endoscopic coronary artery bypass grafting with the da Vinci S surgical system.


METHODS
Between January 2007 and May 2009, 16 patients underwent off-pump coronary artery bypass grafting via a totally endoscopic approach. After anesthetic induction, a left-sided double-lumen endotracheal tube was positioned to allow single right-lung ventilation during intra-operative procedure. The left internal mammary artery graft was harvested and anastomosed with the anterior descending branch with robotic assistance. The hemodynamic status and left ventricular function of each patient were recorded immediately after the induction (T1), after single right-lung ventilation (T2), after dissecting the left internal mammary artery (T3), after using the heart stabilizator (T4) and after the completion of the anastomosis (T5).


RESULTS
The mean arterial blood pressure at T2, T3, and T4 were significantly reduced as compared with that at T1 (P<0.05), and the mean pulmonary artery pressure at T2, T3 and T4, the heart rate (HR) at T2, T3 and T5, the pulmonary capillary wedge pressure at T4 and the central venous pressure at T5 all increased significantly in comparison with those at T1 (P<0.05).


CONCLUSIONS
Although the hemodynamics and the respiratory function in totally endoscopic coronary artery bypass grafting are both extremely unstable as a result of single right-lung ventilation and surgical procedure, the appropriate administration of vasopressors and adjustment of respiratory function in anesthesia can allow the completion of the procedure with acceptable hemodynamics.
Zhou
Qi
Q
Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, China. zq-301@163.com
Wang
Gang
G
Gao
Chang-Qing
CQ
Chen
Ting-Ting
TT
D000368:Aged; D000771:Anesthesia, Intravenous / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012371:Robotics