ROBOTIC PROSTATECTOMY AND ANESTHESIA 

🏈FACTS ABOUT THE SURGERY
▪️There is a master console; surgeon sits here & controls the robotic surgical manipulator, once it has been docked
▪️Robot is bulky and is positioned over the chest and abdomen
▪️Patient is positioned in lithotomy with a steep Trendelenberg tilt
▪️Needs immobility of the patient till the robot is undocked
▪️Table position should not be altered until the surgical instruments are disengaged
▪️Discharge may occur as early as within 24 hours after surgery
🏈ADVANTAGES
▪️Better continence & erectile function 

▪️Less pain and hence less analgesic requirements 

▪️Less blood loss

▪️Shorter hospital stay
🏈ANESTHESIA CONCERNS
▪️Since immobility is very important, it can be established by continuous infusion of a non depolarizing muscle relaxant
▪️As the procedure may take long time, it’s better to use agents with rapid offset
▪️Because patient is positioned in steep head-down position 
➖Ensure pressure points are protected adequately 
➖Fluids are infused cautiously to reduce chances of cerebral and laryngeal oedema ( N.B.: Rule out cerebral oedema in case of delayed emergence )
➖As the position of the robot interferes with resuscitation, prior practice-drills and good communication are necessary to manage such a situation effectively 
➖Epidural analgesia, if at all required, are used only postoperatively, as the steep head-down position will increase the risk of high block
Reference: Irvine M, Patil V. Anaesthesia for robot-assisted laparoscopic surgery. Contin Educ Anaesth Crit Care Pain. 2009; 9(4): 125–129.

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