Robotic CABG

Abstract

Technological advances and increased experience in robotic coronary artery bypass surgery in the last 15 years have expanded and changed the field. Totally endoscopic coronary artery bypass surgery has become more prevalent and innovative. These cardiac cases require proficiency in skills such as management of one-lung ventilation, insertion of specialized catheters, intraoperative monitoring, and transesophageal echocardiography. Anesthesiologists must be familiar with different methods of lung isolation, including management of episodes of hypoxemia, hypercarbia, and sequelae of increased pulmonary vascular resistance during lung isolation. Procedures with arrested heart on cardiopulmonary bypass require expertise in insertion of a percutaneous coronary sinus catheter for administration of retrograde cardioplegia, in addition to insertion of a pulmonary artery vent for left ventricular decompression. Transesophageal echocardiography is essential for placement of specialized cannulas for cardiopulmonary bypass, such as the endoaortic occlusion balloon clamp and remote access perfusion lines. In certain cases, anesthetic technique should facilitate intraoperative extubation and management of postoperative pain.