[Anesthetic management of thoracoscopic mini maze procedure for atrial fibrillation]

We anesthetized three patients with refractory atrial fibrillation undergoing the new thoracoscopic mini Maze procedure. This minimally invasive surgical procedure provides isolation and ablation of the bilateral pulmonary vein without thoracotomy or cardiopulmonary bypass, which was performed first in the United States in 2003. General anesthesia was administrated with a double lumen tracheal tube for bilateral single lung ventilation, and epidural anesthesia was also administrated. We prepared transesophageal echocardiography, a pulmonary artery catheter with pacing wires, and a 20 G arterial line connected to continuous cardiac output monitor. We also prepared a 14 G peripheral intravenous line and two 4 Fr sheaths on the left femoral artery and vein for bleeding and conversion to cardiopulmonary bypass. One patient required massive transfusion and conversion to open procedure with thoracotomy and cardiopulmonary bypass to control sudden and massive bleeding from the pulmonary vein. Another patient was complicated with dextrocardia, but the procedure was successful. One other patient had no complications and the procedure was performed as planned. Certain anesthetic management is essential for this new procedure and we have to prepare for any predictable events.