Two cases of anaesthetic complications after robotic-assisted laparoscopic radical prostatectomy using the da Vinci Remote-Controlled Surgical System are presented. Case 1 describes a patient with post-extubation respiratory distress requiring reintubation and subsequent ventilation in an intensive care unit. This was attributed to laryngeal oedema, which was most likely due to the reduction in venous outflow from the head caused by the pneumoperitoneum and prolonged, extreme Trendelenburg position. Case 2 describes a patient with mild brachial plexus neurapraxia, which was most likely due to compression by shoulder braces (to prevent cephalad sliding) during the exaggerated head-down tilt. For this procedure, the authors recommend limiting the duration and extent of head-down tilt as much as possible, avoiding excessive intravenous fluids and careful positioning of the patient with avoidance of shoulder braces whenever possible.
GettmanM.T., HoznekA., SalomonL., KatzR., BorkowskiT., AntiphonP.Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system.J Urol2003; 170: 416–419.
BrancheP.E., DuperretS.L., SagnardP.E., BoulezJ.L., PetitP.L., VialeJ.P.Left ventricular loading modifications induced by pneumoperitoneum: a time course echocardiographic study.Anesth Analg1998; 86: 482–487.
10.
LeonardI.E., CunninghamA.J.Anaesthetic considerations for laparoscopic cholecystectomy.Best Pract Res Clin Anaesthesiol2002; 16: 1–20.
11.
RosenthalR.J., HiattJ.R., PhillipsE.H., HewittW., DemetriouA.A., GrodeM.Intracranial Pressure: Effects of pneumoperitoneum in a large animal model.Surg Endosc1997; 11: 376–380.
DarmonJ.Y., RaussA., DreyfussD., BleichnerG., ElkharratD., SchlemmerB.Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. A placebo-controlled, double-blind, multicenter study.Anesthesiology1992; 77: 245–251.
14.
MauryE., GuglielminottiJ., AlzieuM., QureshiT., GuidetB., OffenstadtG.How to identify patients with no risk for post-extubation stridor?J Crit Care2004; 19: 23–28.
15.
HoL.I., HarnH.J., LienT.C., HuP.Y., WangJ.H.Post-extubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone.Intensive Care Med1996; 22: 933–936.
16.
NakamuraK., NishikawaK., TakizawaD., KoizukaS., HiraokaH., SaitoS.Postoperative laryngeal oedema presumably due to hypoalbuminaemia causing airway obstruction after extubation in a patient after nephrectomy.Masui2004; 53: 906–909.
17.
De BastY., De BackerD., MoraineJ.J., LemaireM., VandenborghtC., VincentJ.L.The cuff leak test to predict failure of tracheal extubation for laryngeal oedema.Intensive Care Med2002; 28: 1267–1272.
18.
JaberS., ChanquesG., MateckiS., RamonatxoM., VergneC., SoucheB.Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test.Intensive Care Med2003; 29: 69–74.
19.
MarkovitzB.P., RandolphA.G.Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults.Cochrane Database Syst Rev2000; 2: CD001000.
20.
LobatoE.B., PaigeG.B., BrownM.M., BennetB., DavisJ.D.Pneumoperitoneum as a risk factor for endobronchial intubation during laparoscopic gynaecological surgery.Anesth Analg1998; 86: 301–303.
21.
BarashP.G., CullenB.F., StoeltingR.K.Patient Positioning. In: Clinical Anesthesia, 4th edition, Philadelphia PA: Lippincott Williams & Wilkins2001; 642–646.
AbballeC., CamaioniD., MascaroA., BoccardiM., EvangelistaM.Anesthesia for laparoscopic cholecystectomy: the use of nitrous oxide in the anesthetic mixture.G Chir1993; 14: 493–495.
28.
DiemunschP.A., TorpK.D., Van DorsselaerT., MutterD., DiemunschA.M., SchaefferR.Nitrous oxide fraction in the carbon dioxide pneumoperitoneum during laparoscopy under general anaesthesia in pigs.Anesth Analg2000; 90: 951–953.
