ABSTRACT
This article details the anesthetic management of robot-assisted and laparoscopic urologic surgery. It includes the key concerns for anesthetists and a guide template for those learning this specialist area. The emphasis is on the principles of enhanced recovery, the preoperative and risk assessments, as well as the specific management plans to reduce the incidence of complications arising as a result of the prolonged pneumoperitoneum and steep head-down positions necessary for most of these procedures.
Subject(s)
Anesthesia , Anesthesiology/methods , Urologic Surgical Procedures , Humans , Laparoscopy , RoboticsABSTRACT
OBJECTIVE: We report a negative experience of fatal haemorrhage during rigid bronchoscopy when an intrabronchial lesion was biopsied. Despite being prepared for and carrying out emergency sternotomy and clamping the lung hilum, the patient died. METHODS: We reviewed mainly non-surgical literature for recommendations for the management of catastrophic bleeding at bronchoscopy. RESULTS: The literature does provide advice for management of 'massive haemoptysis' defined as more than 600 ml in 24 h and 'exsanguinating haemoptysis' which is at least 1000 ml blood loss at a rate more than 150 ml/h. However there is little in the current surgical literature on the immediate treatment of 'catastrophic haemoptysis' which we define as major bleeding from the airway causing an immediate threat to life requiring immediate surgery. Gathering treatment options from various authors we present a suggested protocol for the management of this thoracic surgical emergency. CONCLUSIONS: We recommend the initial salvage treatment to be: (1) wedge the rigid bronchoscope into the haemorrhaging bronchus, (2) tamponade the bleeding site with a balloon-tipped vascular catheter, (3) remove the bronchoscope and intubate with a double-lumen tube, (4) undertake emergency definitive surgery. We strongly recommend that a suitable catheter be kept immediately available for this very rare but dangerous complication.
