title: Anesthesia management of totally endoscopic atrial septal defect repair with a robotic surgical system.
abstract: OBJECTIVE
  To investigate anesthetic techniques for robot-assisted endoscopic atrial septal defect (ASD) repair.
  
  
  METHODS
  Clinical observational study.
  
  
  METHODS
  Operating room of a general military hospital.
  
  
  METHODS
  56 adult, ASA physical status 1 and 2 patients undergoing elective general anesthesia.
  
  
  METHODS
  After induction of general anesthesia, a left-sided, double-lumen endotracheal tube was positioned to allow single left-lung ventilation and contralateral CO(2) pneumothorax (capnothorax). With ultrasound guidance, peripheral cardiopulmonary bypass (CPB) catheters were placed.
  
  
  RESULTS
  All patients tolerated single left-lung ventilation before CPB; however, hypoxia (oxygen saturation < 90%) occurred in 11 (19.6%) patients post-CPB, which required treatment with continuous positive airway pressure. Fifteen (26.8%) patients had hypotension secondary to capnothorax, which was treated with transfusion and vasopressors. Aortic cross-clamp time was 43.6 ± 11.2 minutes, and CPB time was 106.7 ± 12.4 minutes. The median intensive care unit stay was 21 hours and postoperative hospital stay was 4 to 7 days.
  
  
  CONCLUSIONS
  The key issue for anesthetic management of robot-assisted totally endoscopic ASD repair is maintaining stable hemodynamics and oxygenation, especially during one-lung ventilation and capnothorax.
authors.affiliation: Department of Cardiovascular Surgery and PLA Institute of Cardiac Surgery, General Hospital of PLA, Beijing 100853, China. beijing-baoding@sohu.com
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.forename: Changqing
authors.initials: C
authors.lastname: Gao
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhou
authors.forename: Tingting
authors.initials: T
authors.lastname: Chen
authors.forename: Yao
authors.initials: Y
authors.lastname: Wang
authors.forename: Jiali
authors.initials: J
authors.lastname: Wang
authors.forename: Jiachun
authors.initials: J
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006439:Hemodynamics; D006772:Hospitals, Military; D006801:Humans; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011031:Pneumothorax, Artificial / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods; D012371:Robotics; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods; D055815:Young Adult
chemical_list: D010100:Oxygen