Anesthetic Implications of Robotic Surgery: Positioning and Access
Robot-assisted surgery has many implications for the anesthesiologist. In addition to well-described implications—such as the changes in patient hemodynamics and ventilation seen with the combination of pneumoperitoneum and Trendelenburg (or reverse Trendelenburg) position used in robotic surgery—the size, the shape, and orientation of robotic surgical equipment also have implications for the anesthesiologist. For example, in order to dock the robotic surgical system, the head of the patient is often rotated away from proximity to the anesthesiologist. This affects the position of other equipment in the operating room, reduces access to the patient’s airway, and affects the use of monitoring cables and arterial, central, and intravenous lines. There is an added layer of complexity when converting from a robotic to an open procedure, in which case the orientation of the operating room table must be turned from the robotic positioning to the standard position in order to make optimal use of fixed lighting designed for open surgery. Also, an emergency plan must be in place, and all operating personnel need to be aware of how to quickly undock the robot and turn the patient should conversion to open surgery become urgent or should the administration of emergency therapy such as electronic pacing or defibrillation become necessary. In this chapter, we will summarize the most important anesthetic issues seen with robotic surgery (Table 8.1) and offer some recommendations for operating room practice in order to prevent possible complications associated with robotic surgery (Table 8.2) [1–3].
KeywordsAnesthesia Cardiopulmonary risks Disaster preparedness Positioning risks Renal risks