Minimal invasive cardiac surgery- Anesthesia

Anesthetic management of Minimal invasive cardiac surgery

1. Dr.Rajkumar . MD, EDAIC, DM Anaesthesia for minimally invasive cardiac surgery

2. Advantages of minimally invasive cardiac surgery Shorter ICU stay Enhanced recovery Better cosmesis and patient satisfaction Quicker resumption of normal activities Reduced blood loss Less inflammation Less blood transfusion Less invasive

3. Anesthetic Concerns Thoracotomy with One lung ventilation Hypoxemia FEV1 and DLCO Pulmonary hypertension Peripheral bypass cannulation Positioning Transesophageal Echo

4. One lung ventilation- DLT

5. One lung ventilation

6. Monitoring

7. positioning Supine with with a slightly elevated hemithorax Brachial plexus injury External defibrillation

8. Analgesia Thoracic epidural Paravertebral block Serratus anterior plane block Intrapleural block Erector spinae block

9. TEE Cannula position Aortic regurgitation Size and morphology of Aortic root RV function Endoballoon positioning Other pathologies

10. Role of TEE

11. Role of tee Ascending aortic dissection diagnosed by transesophageal echocardiography in the longitudinal (A) and transversal (B) views, with identification of the intimal flap (arrows).

12. TOE midoesophageal aortic valve long axis view. Cardioplegia solution has been delivered to the coronary arteries via the central lumen of the endoballoon

13. TEE- Evaluation of atria and interalral septum

14. Assessment of pulmonary hypertension

15. Venous cannulation Mid esophageal bicaval view showing Guidewire in SVC

16. ME bicaval view showing Guidewire in RA during threading of cannula.

17. ME bicaval view showing Venous cannula for CPB in Right atrium

18. TEE showing IVC and Right hepatic vein

19. Descending thoracic aorta

20. Deairing –weaning from bypass

21. Left superior Vena cava opening into Coronary sinus

22. Coronary sinus and SVC – Useful to deliver retrograde cardioplegia

23. MICS E ver growing technical expertise coupled with patient’s awareness has led to the tremendous growth of MICS. The potential benefits are many and include reduced pain and hospital stay as well as increased patient satisfaction The safe and complications‑free conduct of MICS is a huge challenge requires complete coordination of Cardio thoracic team