Mehmet Emin İNCE, Nadide ÖRS, Gökhan ÖZKAN, Murat KADAN, Gökhan EROL, Suat DOĞANCI, Cengiz BOLCAL, Vedat YILDIRIM

Robotik Kalp Cerrahisinde Anestezi Yönetimi: Klinik Deneyimlerimiz

Amaç: Minimal invaziv cerrahi yaklaşımlar çeşitli potansiyel yararlarının yanı sıra anestezi ve cerrahi ekipleri için yeni zorlukları da beraberinde getirmiştir. Bu çalışmada, kliniğimizde gerçekleştirilen robotik kardiyak cerrahi işlemlerindeki anestezi deneyimimizi güncel bilgiler eşliğinde sunmayı amaçladık. Yöntem: Bu çalışma, Ekim 2014-Aralık 2019 tarihleri arasında sağ torakotomi ile robotik kardiyak cerrahi geçiren 227 (120 erkek, 107 kadın) hastayı içermektedir. Hastalara ait demografik veriler, cerrahi tipi, EuroSCORE değerleri, kros-klemp ve pompa süresi, postoperatif komplikasyonlar, yoğun bakımda ve hastanede kalış süreleri hasta dosyalarından ve anestezi takip formlarından taranarak elde edildi. Bulgular: Robotik kardiyak cerrahi ile 101 hastaya ASD-VSD, 114 hastaya kapak cerrahisi ve 13 hastaya intrakardiyak kitle eksizyonu işlemi yapıldı. Bu işlemlerden 15’i atan kalpte gerçekleştirildi. Ameliyat sonrası hastaların median ekstübasyon süresi 5 saat, median yoğun bakım kalış süresi 1 gün ve median hastanede kalış süresi 7 gün idi. Postoperatif dönemde uzamış mekanik ventilasyon gereksinimi nedeniyle 3 hastaya trakeostomi açıldı. Kapak cerrahisi yapılan hastalardan 10’una kalıcı kalp pili implantasyonu yapıldı. Sonuç: Hem torasik hem de kardiyak cerrahinin tüm özelliklerini içeren robotik kardiyak cerrahide anestezistlerin oluşabilecek komplikasyonları bilmesi ve bunlara karşı önceden plan yapması gerekmektedir. Ayrıca özellikli bu cerrahinin ayrılmaz bir parçası olan tek akciğer ventilasyonu ve transözofageal ekokardiyografi için gerekli olan bilgi birikiminin kazanılması gerekmektedir

Anesthetic Management in Robotic Cardiac Surgery: Our Clinical Experiences

Objective: Minimally invasive surgical approaches have various potential benefits, as well as new challenges for anesthesia and surgical teams. In this study, we aimed to present our anesthesia experience in robotic cardiac surgery procedures performed in our clinic with current information. Method: This study included 227 (120 men, 107 women) patients who underwent robotic cardiac surgery performed via right thoracotomy between October 2014 and December 2019. Demographic data, type of surgery, EuroSCORE values, cross-clamp and cardio-pulmonary bypass time, postoperative complications, length of intensive care and hospital stays were obtained by screening patients’ files and anesthesia follow-up forms. Results: ASD-VSD was performed in 101 patients, valve surgery in 114 patients, and intracardiac mass excision in 13 patients using robotic surgery. Fifteen procedures were performed as the beating heart surgery. Median extubation time of the patients after surgery was 5 hours, median length of intensive care and hospital stays were 1, and 7 days, respectively. Due to the need for prolonged mechanical ventilation in the postoperative period, 3 patients underwent tracheostomy. Permanent pacemaker implantation was performed in 10 of the patients undergoing valve surgery. Conclusion: In robotic cardiac surgery, which includes all features of both thoracic and cardiac surgery, anesthetists must know the complications that may occur and make a plan in advance against them. In addition, it is necessary to acquire the knowledge required for single- lung ventilation and transesophageal echocardiography, which is an integral part of this particular surgery.

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