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Anesthetic Considerations for Robotic Urologic Surgery

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Book cover Robotics in Genitourinary Surgery

Abstract

The proper management of anesthesia for robotic-assisted laparoscopic urologic surgery (RALUS) must focus on the complex physiology and implications of Pneumoperitoneum (PPT) and the Trendelenburg position (TP) which challenge the neurologic, ocular, pulmonary, cardiovascular, and renal systems. The type of inflation gas and degree of abdominal and hydrostatic pressure proportionally affect these systems, while restricted access to the limbs hinders routine monitoring, interpretation, venous access, and safety. The cardiovascular effects are profound, but generally well tolerated and hidden, whereas the management of ventilation becomes far more difficult. Special techniques for monitoring neuromuscular blockade (NMB), blood pressure (BP), and central venous pressure (CVP) are indicated. Pre-anesthetic evaluation, surgical positioning, drug effects, airway and fluid management, and recognition of common complications ought to inform the specific conduct of anesthesia, while the experience of the surgeon may have the most profound influence over the course of anesthesia.

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Abbreviations

AICD:

Automated implantable cardiac defibrillator

AION:

Anterior ischemic optic neuropathy

APSF:

Anesthesia Patient Safety Foundation

ASA:

American Society of Anesthesiologists

BP:

Blood pressure

CBF:

Cerebral blood flow

CC:

Closing capacity

CO:

Cardiac output

COPD:

Chronic obstructive pulmonary disease

CPAP:

Continuous positive airway pressure

CPP:

Cerebral perfusion pressure

CPT:

Capnoperitoneum

CSF:

Cerebrospinal fluid

CVP:

Central venous pressure

EA:

Epidural analgesia

EAES:

European Association of Endoscopic Surgery

EDV:

End-diastolic volume

ETT:

Endotracheal tube

FRC:

Functional residual capacity

GA:

General anesthesia

GFR:

Glomerular filtration rate

HR:

Heart rate

IAP:

Intra-abdominal pressure

ICP:

Intracranial pressure

IOP:

Intraocular pressure

IPSC:

Intermittent pneumatic sequential compression

LA:

Local anesthetics

LMWH:

Low molecular weight heparin

MAP:

Mean arterial pressure

MPAP:

Mean pulmonary artery pressure

NMB:

Neuromuscular blockade

NMDA:

N-methyl-D-aspartate

NSAIDs:

Non-steroidal anti-inflammatory drugs

OSA:

Obstructive sleep apnea

PAOP:

Pulmonary artery occlusion pressure

PAP:

Pulmonary artery pressure

PCA:

Patient-controlled analgesia

PCEA:

Patient-controlled epidural analgesia

PCV:

Pressure-controlled ventilation

PCWP:

Pulmonary capillary wedge pressure

PE:

Pulmonary embolism

PION:

Posterior ischemic optic neuropathy

PMMA:

Pharmacologic multimodal analgesia

POI:

Postoperative ileus

POVL:

Postoperative vision loss

PPT:

Pneumoperitoneum

PVR:

Pulmonary vascular resistance

RALRP:

Robotic-assisted laparoscopic radical prostatectomy

RALS:

Robotic-assisted laparoscopic surgery

RALUS:

Robotic-assisted laparoscopic urologic surgery

RBF:

Renal blood flow

SAB:

Subarachnoid block

SV:

Stroke volume

SVR:

Systemic vascular resistance

TAP:

Transversus abdominis plane

TEA:

Thoracic epidural analgesia

TIVA:

Total intravenous anesthesia

TLC:

Total long capacity

TP:

Trendelenburg position

UOP:

Urine output

VCV:

Volume-controlled ventilation

VILI:

Ventilator-induced lung injury

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Authors and Affiliations

  1. Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA

    Michael A. Olympio

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  1. Michael A. Olympio
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Correspondence to Michael A. Olympio .

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  1. Department of Urology Comprehensive Cancer Center Wake Forest Institute for Regenerative Medicine Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Ashok K. Hemal

  2. Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA

    Mani Menon

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Olympio, M.A. (2018). Anesthetic Considerations for Robotic Urologic Surgery. In: Hemal, A., Menon, M. (eds) Robotics in Genitourinary Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-20645-5_4

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  • DOI: https://doi.org/10.1007/978-3-319-20645-5_4

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