Anesthetic Management in Minimally Invasive Cardiac Surgery
Özet
This chapter focuses on anesthetic management in minimally invasive cardiac surgery (MICS). The anesthetic approach varies based on the surgical incision and perfusion method. Intraoperative transesophageal echocardiography (TEE) is routinely used, along with single-lung ventilation for specific procedures. Preoperative evaluations focus on the patient’s respiratory function and overall health. During surgery, standard monitoring and cerebral oxygenation assessments are employed. Anesthesia management is carefully planned to ensure patient comfort and facilitate surgical success.
Bu bölümde minimal invaziv kalp cerrahisinde anestezi yönetimi ele alınmaktadır. MICS'te anestezi yaklaşımı, cerrahi insizyon türüne ve kullanılan perfüzyon yöntemine göre değişiklik gösterir. Transözofageal ekokardiyografi (TEE) rutin olarak kullanılırken, tek akciğer ventilasyonu da tercih edilir. Preoperatif değerlendirmede hastanın solunum fonksiyonları ve genel sağlık durumu detaylıca incelenmelidir. Operasyon sırasında standart monitörizasyonun yanı sıra beyin oksijenizasyonu da takip edilir. Anestezi yönetimi, hastanın konforunu sağlamak ve cerrahi süreci kolaylaştırmak adına titizlikle planlanır.
Referanslar
Cosgrove DM , Sabik JF, Navia JL. Minimally invasive valve operations. Ann Thorac Surg 1998;65:1535‐8.
Campos JH. Current techniques for perioperative lung isolation in adults. Anesthesiology 2002;97(5):1295-301.
Ganapathy S. Anaesthesia for minimally invasive cardiac surgery. Best Pract Res Clin Anaesthesiol 2002;16(1):63-80.
Seco M, Edelman JJ, Yan TD, Wilson MK, Bannon PG, Vallely MP. Systematic review of robotic‐assisted, totally endoscopic coronary artery bypass grafting. Ann Cardiothorac Surg 2013;2:408‐18.
Feuchtner GM, Schachner T, Bonaros N, Smekal A, Mallouhi A, Friedrich GJ, et al. Evaluation of ascending aortic atherosclerosis with 16‐multidetector computed tomography is useful before total endoscopic coronary bypass surgery. Heart Surg Forum 2006;9:E754‐8.
Hilberath JN, Oakes DA, Shernan SK, Bulwer BE, D'Ambra MN, Eltzschig HK. Safety of transesophageal echocardiography. J Am Soc Echocardiogr 2010;23(11):1115-27.
Bernstein WK, Walker A. Anesthetic issues for robotic cardiac surgery. Ann Card Anaesth 2015;18:58–68.
Deshpande SP, Lehr E, Odonkor P, et al. Anesthetic management of robotically assisted totally endoscopic coronary artery bypass surgery (TECAB). J Cardiothorac Vasc Anesth 2013;27:586–99.
Bhatt HV, Schuessler ME, Torregrossa G, Fitzgerald MM, Evans AS, Narasimhan S, et al. Robotic Cardiac Surgery Part II: Anesthetic Considerations for Robotic Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2020;34(9):2484-2491.
Monaco F, Belletti A, Bove T, Landoni G, Zangrillo A. Extracorporeal Membrane Oxygenation: Beyond Cardiac Surgery and Intensive Care Unit: Unconventional Uses and Future Perspectives. J Cardiothorac Vasc Anesth 2018;32(4):1955-1970.
Prempeh ABA, Scherman J, Swanevelder JL. Transesophageal echocardiography in minimally invasive cardiac surgery. Current Opinion in Anaesthesiology 2020;33(1): 83-91.
Klein AA, Snell A, Nashef SA, Hall RM, Kneeshaw JD, Arrowsmith JE. The impact of intra-operative transoesophageal echocardiography on cardiac surgical practice. Anaesthesia 2009; 64: 947–52.
Eltzschig HK, Rosenberger P, Loffler M, Fox JA, Aranki SF, Shernan SK. Impact of intraoperative transesophageal echocardiography on surgical decisions in 12,566 patients undergoing cardiac surgery. Annals of Thoracic Surgery 2008; 85: 845–52.
Gravlee GP, ed. Cardiopulmonary bypass: principles and practice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008. p. 783.
Mongero LB, Beck JR, eds. On bypass: advanced perfusion techniques. New York: Springer Science & Business Media; 2008. p. 576.
Murzi M, Glauber M. Central versus femoral cannulation during minimally invasive aortic valve replacement. Ann Cardiothorac Surg 2015;4(1):59-61.
De Somer F. Venous drainage--gravity or assisted? Perfusion 2011;26(1):15-9.
Riley W, FitzGerald D, Cohn L. Single, percutaneous, femoral venous cannulation for cardiopulmonary bypass. Perfusion 2007;22(3):211-5.
Franco KL, Vinod HT. Cardiothoracic surgery review. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 1770.
Muehling BM, Halter GL, Schelzig H, Meierhenrich R, Steffen P, Sunder-Plassmann L, et al. Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur J Cardiothorac Surg 2008;34:174–180.
Sherazee EA, Chen SA, Li D, Li D, Frank P, Kiaii B. Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery. Innovations (Phila) 2022;17(3):167-176.
Camp SL, Stamou SC, Stiegel RM, et al. Quality improvement program increases early tracheal extubation rate and decreases pulmonary complications and resource utilization after cardiac surgery. J Card Surg 2009; 24: 414–423.
Smith C. Manion, Timothy J. Brennan, Bruno Riou; Thoracic Epidural Analgesia and Acute Pain Management. Anesthesiology 2011;115:181–188.
Nygård E, Kofoed KF, Freiberg J, Holm S, Aldershvile J, Eliasen K, et al. Effects of high thoracic epidural analgesia on myocardial blood flow in patients with ischemic heart disease. Circulation 2005;111:2165–70.
Beattie WS, Badner NH, Choi PT. Meta-analysis demonstrates statistically significant reduction in postoperative myocardial infarction with the use of thoracic epidural analgesia. Anesth Analg 2003;97:919–20.
Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy. American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med 2018;43(3):263-309.
D'Ercole F, Arora H, Kumar PA. Paravertebral Block for Thoracic Surgery. J Cardiothorac Vasc Anesth 2018;32(2):915-927.
Karmakar MK. Ultrasound-guided thoracic paravertebral block. Tech Reg Anesth Pain Management 2009;13:142–9.
Naja Z, Lönnqvist PA. Somatic paravertebral nerve blockade: Incidence of failed block and complications. Anaesthesia 2001;56:1184–8.
Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016;41: 621–627.
De Cassai A, Bonvicini D, Correale C, Sandei L, Tulgar S, Tonetti T. Erector spinae plane block: a systematic qualitative review. Minerva Anestesiol 2019;85(3):308-319.
Toscano A, Capuano P, Galatà M, Tazzi I, Rinaldi M, Brazzi L. Safety of ultrasound-guided serratus anterior and erector spinae fascial plane blocks: a retrospective analysis in patients undergoing cardiac surgery while receiving anticoagulant and antiplatelet drugs. J Cardiothorac Vasc Anesth 2022;36:483–488.
Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 2013;68:1107–1113.
Park MH, Kim JA, Ahn HJ, Yang MK, Son HJ, Seong BG. A randomised trial of serratus anterior plane block for analgesia after thoracoscopic surgery. Anaesthesia 2018;73(10):1260-1264.
Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified PecsI):a novel approach to breast surgery. Rev Esp Anestesiol Reanim 2012;59(9):470-5.
Kumar KN, Kalyane RN, Singh NG, Nagaraja PS, Krishna M, Babu B, et al. Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery. Ann Card Anaesth 2018;21(3):333-338.
Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin 2008;26(2):355-67.
Lahtinen P, Kokki H, Hendolin H, Hakala T, Hynynen M. Propacetamol as adjunctive treatment for postoperative pain after cardiac surgery. Anesth Analg 2002;95(4):813-9.
Della Rocca G, Coccia C, Pompei L, Costa MG, Pierconti F, Di Marco P, et al. Post-thoracotomy analgesia: epidural vs intravenous morphine continuous infusion. Minerva Anestesiol 2002;68(9):681-93.
Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA Surg 2019;154:755–766.
Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg 2017;152: 691–697.
Hynninen MS, Cheng DC, Hossain I, Carroll J, Aumbhagavan SS, Yue R, et al. Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery. Can J Anaesth 2000;47(12):1182-7.
Dastan F, Langari ZM, Salamzadeh J, Khalili A, Aqajani S, Jahangirifard A.A Comparative study of the analgesic effects of intravenous ketorolac, paracetamol, and morphine in patients undergoing video-assisted thoracoscopic surgery: a double-blind, active-controlled, randomized clinical trial. Ann Card Anaesth 2020;23:177–182.
