Anesthetic Challenges in Minimally Invasive Cardiac Surgery

Balasubramanyam, Uma; Kapoor, Poonam Malhotra

doi:10.1055/s-0039-3401464

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…The presence of plaques, aneurysms, dissections, tortuosity, or foreign vascular material (grafts or stents) might preclude peripheral cannulation. If endoballoon clamping is planned, higher degree of aortic valve insufficiency and aortic vascular disease, such as an aneurysmal ascending aorta or effacement of the sinotubular junction, must be excluded (3,4). Many centers include CT angiography in the workup to MICS.…”

Section: Cardiovascularmentioning

confidence: 99%

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Anesthesia for minimally invasive cardiac surgery

White¹,

Patvardhan²,

Falter³

2021

J Thorac Dis

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Due to its potential benefits and increased patient satisfaction minimal invasive cardiac surgery (MICS) is rapidly gaining in popularity. These procedures are not without challenges and require careful planning, pre-operative patient assessment and excellent intraoperative communication. Assessment of patient suitability for MICS by a multi-disciplinary team during pre-operative workup is desirable.MICS requires additional skills that many might not consider to be part of the standard cardiac anesthetic toolkit. Anesthetists involved in MICS need not only be highly skilled in performing transesophageal echocardiography (TEE) but need to be proficient in multimodal analgesia, including locoregional or neuroaxial techniques. MICS procedures tend to cause more postoperative pain than standard median sternotomies do, and patients need analgesic management more in keeping with thoracic operations.Ultrasound guided peripheral regional anesthesia techniques like serratus anterior block can offer an advantage over neuroaxial techniques in patients on anti-platelet therapy or anticoagulation with low molecular weight or unfractionated heparin The article reviews the salient points pertaining to pre-operative assessment and suitability, intraoperative process and postoperative management of minimally invasive cardiac procedures in the operating theatre as well as the catheterization lab. Special emphasis is given to anesthetic management and analgesia techniques.

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Section: Cardiovascularmentioning

confidence: 99%

“…Arterial blood gas sampling and carbon monoxide diffusion capacity (DLCO) are suggested to assess gas exchange. Traditionally, a PaO 2 <60 mmHg or a PaCO 2 >50 mmHg preclude the use of one-lung ventilation (OLV) (4,5), DLCO values <40% are associated with increased incidence of postoperative pulmonary complications (5).…”

Section: Respiratorymentioning

confidence: 99%

Anesthesia for minimally invasive cardiac surgery

White¹,

Patvardhan²,

Falter³

2021

J Thorac Dis

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“…MICS are cardiac surgeries through several small thoracic or sternal incisions or through percutaneous approaches. [ 24 ]…”

Section: Minimally Invasive Cardiac Surgeries and Anaesthesiamentioning

confidence: 99%

Recent advances in cardiac anaesthesia

Sundar

Ramachandran

Venugopal

et al. 2023

Indian Journal of Anaesthesia

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The speciality of cardiac anaesthesia has rapidly evolved over the past few decades with advances in technology, including artificial intelligence (AI), newer devices, techniques, imaging, pain relief and a better understanding of the pathophysiology of disease states. Incorporation of the same has led to improved patient outcomes in terms of morbidity and mortality benefits. With the advent of minimally invasive surgical methods, minimising the dose of opioids and ultrasound-guided regional anaesthesia for pain relief, enhanced recovery after cardiac surgery has been made possible. Perioperative imaging including 3D transoesophageal echocardiography, newer devices and drugs and AI algorithms will play a significant role in cardiac anaesthesia. This review briefly addresses some of the recent advances that the authors believe can impact the practice of cardiac anaesthesia.

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“…Embracing minimally invasive technologies in cardiac surgery significantly mitigated the intra- and post-operative surgical trauma and complications, compared to the traditional open heart surgery. 1–3 By the percutaneous deployment of catheters and guide-wires through small incisions, Minimally Invasive Cardiac Surgery (MICS) ameliorates the state-of-the-art of heart surgery not only by eliminating the need for long chest incisions, but also allowing the performance on the beating heart. Although MICS is a major convenience for patients, it imposes several challenges from the physicians’ point-of-view.…”

Section: Introductionmentioning

confidence: 99%

Exploiting the instability of eccentric tube robots for distal force control in minimally invasive cardiac ablation

Alfalahi

Renda

Messer

et al. 2021

Proceedings of the Institution of Mechanical Engineers, Part C:

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While the dilemma of motion tracking and force control in beating-heart surgery is previously addressed using active control architectures and rigid robotic actuators, this work leverages the highly controllable mechanical properties of concentric tube robots for intelligent, design-based force control in minimally invasive cardiac ablation. Briefly, cardiac ablation is the conventional procedure for treating arrhythmia patients, by which exposing the diseased cardiac tissue to Radio-Frequency (RF) energy restores the normal heart rhythm. Yet, the procedure suffers low success rate due to the inability of existing flexible catheters to maintain a consistent, optimal contact force between the tip electrode and the tissue, imposing the need for future repeat surgeries upon disease recurrence. The novelty of our work lies in the development of a statically-balanced compliant mechanism composed of (1) distal bi-stable concentric tubes and (2) a compliant, torsional spring mechanism that provides torque at tubes proximal extremity, resulting in an energy-free catheter with a zero-stiffness tip. This catheter is expected to maintain surgical efficacy and safety despite the chaotic displacement of the heart, by naturally keeping the tip force at an optimal level, not less and not more than the surgical requirement. The presented experimental results of the physical prototype, reflect the feasibility of the proposed design, as well as the robustness of the formulated catheter mathematical models which were uniquely deployed in the selection of the optimal design parameters.

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Anesthetic Challenges in Minimally Invasive Cardiac Surgery

Cited by 5 publications

References 30 publications

Anesthesia for minimally invasive cardiac surgery

Anesthesia for minimally invasive cardiac surgery

Recent advances in cardiac anaesthesia

Exploiting the instability of eccentric tube robots for distal force control in minimally invasive cardiac ablation

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