ABSTRACT
Minimally invasive cardiac surgery including robotic technique has become increasingly popular over the last decade. The advantages of such technique include improved cosmesis and healing, and reduced stress response, hospital and intensive care unit stay, and transfusion requirements. Robot-assisted cardiac surgery requires prolonged one-lung ventilation to optimize exposure. Remote-access perfusion requires appropriate positioning of multiple catheters to establish cardiopulmonary bypass. Carbon dioxide insufflation into the thorax can cause hemodynamic instability and carbon dioxide embolism. Limited exposure of the heart may pose difficulties with management of arrhythmia, hemostasis, myocardial protection and de-airing at the end of surgery. Limited access due to robot manipulator would make rapid intervention for cardiopulmonary resuscitation difficult or impossible. This case report describes robot-asssisted atrial septal defect repair and discusses the anesthetic issues associated with minimally invasive cardiac surgery including robotic cardiac surgery.