ObjectiveTo summarize the management of anesthesia during robotic off-pump coronary artery bypass grafting (CABG) with the da Vinci surgical system in minimal thoractomy. MethodsFrom May 2011 to December 2014, 24 patients (20 males and 4 females) at the average age of 62.1±12.8 years underwent robotic off-pump CABG with the da Vinci surgical system in our hospital. All the patients underwent the continuous invasive blood pressure monitoring, endotracheal intubation with the double-lumen tube after induction of general anesthesia, fiber bronchoscope positioning, intraoperative application of one-lung ventilation, placing the Swan-Ganz floating catheter, and monitoring the echocar-diography (TEE) and blood gas analysis and indexes of hemodynamics. ResultsAll the patients were stable during the anesthesia induction period. There was no severe hypoxemia and hypercapnia. The surgery was successful and there was no thoracotomy. All the patients left off breathing machine postoperatively.The duration of mechanical ventilation was 5.3±2.8 hours. All patients were moved out from ICU in 18 hours.There was no thoracotomy for hemostasis after surgery. All the patients were discharged on the fourth or fifth day postoperatively. There was no death relevant to surgery or perioperative complications. There was no recurrence of cardiovascular events on the 30th day,3 months and 6 months postoperative follow-up. ConclusionThis anesthesia method is safe and effective. It is a rapid recovery way with the fewer complications, less suffering of the patients, reliable anesthesia management and high satisfaction of the patients'.
ObjectiveTo systematically review the efficacy and safety of hemihepatic blood flow occlusion versus Pringle's maneuver during hepatectomy. MethodsWe electronically searched The Cochrane Library (Issue 8, 2013), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) about hemihepatic blood flow occlusion versus Pringle's maneuver during hepatectomy. The duration of search was from the inception of the databases to August 2013. Meanwhile, references of the included studies were also retrieved. After literature selection, data extraction and quality assessment conducted by two reviewers independently, meta-analysis was conducted using RevMan 5.2 software. ResultsSeven studies involving 624 patients were finally included. The results of meta-analysis showed that: a) for safety, Pringle's maneuver was shorter than hemihepatic blood flow occlusion in operation time (SMD=0.34, 95%CI 0.02 to 0.66, P=0.04). But they were alike in intraoperative blood loss, transfusion requirements, hospitalization time, and complications. b) For effectiveness, Pringle's maneuver was lower than hemihepatic blood flow occlusion in the levels of 3rd day ALT (SMD=-0.71, 95%CI-1.28 to-0.14, P=0.02), 7th day ALT (SMD=-1.73, 95%CI-2.85 to-0.62, P=0.002), 1st day AST (SMD=-0.74, 95%CI-1.38 to-0.09, P=0.03), 7th day AST (SMD=-0.99, 95%CI-1.26 to-0.71, P < 0.000 01), 3rd day TBIL (SMD=-0.34, 95%CI-0.57 to-0.10, P=0.005), and 7th day TBIL (SMD=-0.52, 95%CI-1.02 to-0.01, P=0.04). ConclusionCompared to the Pringle's maneuver, hemihepatic blood flow occlusion during hepatectomy could promote the recovery of liver function. However, the number of the included RCTs in the review is small and the quality is low, some of the main information is not reported and the information for analysis lacks. Therefore, the aforementioned conclusion needs to be verified by conducting more large-scale, multicenter and high-quality RCTs.