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Robot-Assisted Surgery: A Word of Caution

Today, you are anesthetizing a 3-mo-old, 6.1 kg infant with biliary atresia. The operation is scheduled for laparoscopic Kasai using a robot-assisted surgical system. The system consists of a remote operating console and a wide-base surgical cart. Inhaled anesthesia with sevoflurane, peripheral IV access, securing the airway with an endotracheal tube, and a radial lineinserted in the operating room (OR). The endotracheal tube position is confirmed by auscultation, and a precordial stethoscope is placed over the patient’s left chest. An orogastric tube is used to decompress the stomach. The patient is elevated approximately 4 in off the OR table on blankets and an egg crate to allow the greatest range of motion for the robotic arms. The OR table is positioned in a 30 degree reverse Trendelenburg to facilitate surgical exposure. The operation proceeds with placement of the robotic cart and arms. Thirty minutes into the case, there is a gradual drop in blood pressure. There is no obvious bleeding, but you are concerned. A medical student suggests that you put the patient in Trendelenburg, as he observes that the child has his feet down. Is this a good idea?

Keywords

Operating Room Biliary Atresia Robotic Instrument Orogastric Tube Arterial Blood Pressure Monitoring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Mariano ER, Furukawa L, Woo RK, Albanese CT, Brock-Utne JG. Anesthesia concerns for robot-assisted laparoscopy in an infant. Anesth Analg 2004;99:1665-1667.CrossRefPubMedGoogle Scholar
  2. 2.
    Joris JL, Noirot DP, Legrand MJ, et al. Hemodynamic changes during laparo-scopic cholecystectomy. Anesth Analg 1993;76:1067-1071.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

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