Anesthetic considerations for robotic urologic 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.