[Anesthetic Management of Robotic Cardiac Surgery]

Traditional cardiac surgery is performed via median sternotomy to approach the mediastinum and coronary structures. Recently, the use of minimal invasive car- diac surgery (MICS) via right mini-thoracotomy has become introduced. Furthermore, robotic-assisted car- diac surgery, with da Vinci® Surgical System, has been introduced. We herein summarize anesthetic manage- ment for robotic-assisted mitral valve surgery. After the induction of anesthesia, the venous cannula was maintained through the right internal jugular vein. Intraoperative transesophageal echo (TEE) is important for guiding the cannula to the right position. Moreover, anesthesiologists must evaluate the myocardial function and the mitral valve before and after the surgical pro- cedure. One-lung ventilation is required to produce ports for the robotic arms. If hypoxemia occurs before beginning the robotic procedure, then bilateral lung ventilation is needed. As robotic cardiac surgery is a completely endo- scopic mitral valve surgery, anesthesiologists must understand the details of the surgical procedure and the findings of the TEE examination.