Preventive Strategies in Anesthetizing a High-Risk Patient for Robotic Surgery: A Case Report

The physiologic consequences of intraabdominal insufflation and extreme positioning in robotic surgery predispose a patient with heart failure to complications. Reports on anesthetic strategies to prevent adverse events in patients with heart failure undergoing these types of surgeries are sparse. A 65-year-old male, who was a known case of heart failure with reduced ejection fraction (EF), was scheduled for robot-assisted low anterior resection for rectal adenocarcinoma. Preoperative diagnostic tools such as echocardiography, 12-lead electrocardiography, and blood tests guided preoperative risk assessment, and anesthesia-related planning and interventions. A balanced anesthetic technique using sevoflurane, atracurium, and fentanyl, with postoperative bilateral rectus sheath and subcostal block was used. In addition to standard monitors, arterial pulse pressure variation (PPV) was utilized for goal-directed fluid therapy to prevent complications. Patient tolerated surgery and anesthesia well with no report of any complication during the perioperative course. Patient was eventually discharged and scheduled for follow-up. The physiologic consequences of robotic surgery compound the already elevated risk for complications of a patient with heart failure. Anesthetic strategies to actively prevent adverse events are of paramount importance.