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?


Operating Room Biliary Atresia Robotic Instrument Orogastric Tube Arterial Blood Pressure Monitoring 
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    Joris JL, Noirot DP, Legrand MJ, et al. Hemodynamic changes during laparo-scopic cholecystectomy. Anesth Analg 1993;76:1067-1071.CrossRefPubMedGoogle Scholar

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