Anesthesia for minimally invasive cardiac surgery

Abstract

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.

Unexpected Tension Pneumothorax after Double-Lumen Endotracheal Intubation in Patients with Pulmonary Edema: A Case Report

“…However, despite the superior perioperative outcomes of this technique compared to conventional sternotomy, its application is limited due to the exposure difficulties of the mitral valve and the risk of cerebrovascular accidents [ 16 ]. Moreover, when the patient has a respiratory problem, minimally invasive mitral valve surgery requiring one-lung ventilation may increase the risk of intraoperative hypoxemia [ 17 ]. In this case, the patient showed a slight improvement in pulmonary edema with preoperative diuretic administration, and the surgeon selected this surgical method in consideration of its advantages over its risks.…”

Catheter-based serratus anterior plane block vs. continuous wound infiltration for postoperative pain control following minimally invasive atrioventricular valve surgery : a randomized, prospective trial

“…A paravertebral block, whether continuous or not, can also provide effective postoperative analgesia, with a higher safety margin compared to thoracic epidural analgesia. Additionally, it has a quick learning curve with a low risk of block failure and a similar effect on analgesia as epidural analgesia 26 .…”

Minimal Access Tricuspid Valve Surgery

“…Cerebral (and/or peripheral) oximetry monitoring and depth of anaesthesia/EEG surveillance are also commonly used. Centres describe a variety of ventilation strategies including intermittent ventilation of a single-lumen endotracheal (ET) tube or lung isolation via either double-lumen ET tubes or single-lumen ET tubes with bronchial blockers [ 18 , 19 ]. Once the patient is under general anaesthesia, central venous lines are placed and, occasionally, Swan-Ganz catheters may be used.…”