The da Vinci Surgical System is a robotic surgical system made by the American company Intuitive Surgical. Approved by the Food and Drug Administration (FDA) in 2000, it is designed to facilitate surgery using a minimally invasive approach, and is controlled by a surgeon from a console. Robotic surgery has gained popularity worldwide recently in different surgical domains, the mastering of robotic manipulation by the surgeons has been a challenging when it first emerged but training and practice led to improvement in both the efficiency and efficacy of surgical techniques. The idea of anesthesia for robotic thoracic surgery could be frightening to anesthetists who have never done it before, but learning the technical difficulties and the specific considerations will help building the confidence towards a safe anesthetic management. In this overview we will discuss the interaction between the robot and the patient, patient position, anesthetic management, expected complications and troubleshooting them.

Background and objectives Postcardiac surgery-associated acute kidney injury (AKI) is associated with up to 60% mortality rates of all cardiac surgery patients. This study aimed to study the renal-protective effect of dexmedetomidine in reducing the incidence of AKI following cardiac surgery. Patients and methods A total of 40 patients scheduled for cardiac surgery with cardiopulmonary bypass (CPB) were randomly allocated into two equal groups. In the study group, dexmedetomidine was given as an infusion of 0.4 μg/kg/h from induction of anesthesia till the end of surgery while in the control group, the patients received an equal volume of normal saline. The primary outcome of this study was the level of serum neutrophil gelatinase-associated lipocalin. The secondary outcomes were serum creatinine, hemodynamic parameters, operative time, aortic cross-clamp time, CPB time, and duration of ICU stay. Results Intraoperative and postoperative time variables and number of patients who developed hypotension were comparable between groups. Bradycardia developed more frequently in the dexmedetomidine group than in the placebo group. Serum neutrophil gelatinase-associated lipocalin after 2 h showed a statistically significant difference between groups. Serum creatinine showed no statistically significant difference between groups. Conclusion Dexmedetomidine could have a protective role in renal function during cardiac surgery using the CPB.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an uncommon hereditary arrhythmogenic syndrome, with an estimated prevalence of ∼0.1/1000. In this disease, myocardial calcium receptors are, more than usual, sensitive to catecholamine release, leading to severe tachyarrhythmias after emotional or physical stress. To the best of our knowledge, only a few cases of general anesthesia (GA) in patients with CPVT have been reported in literature, and none for potentially arrhythmogenic procedures like laser lead extraction. We describe the case of a 17-year-old male patient with CPVT, undergoing GA, for laser lead extraction of an old implantable cardioverter-defibrillator. The procedure, conducted in totally intravenous anesthesia, was uneventful, and just a few sporadic ventricular extrabeats owing to mechanical manipulation of the old wire were reported. The patient was extubated in the operation theater and discharged the following day. In the discussion, the case is analyzed, the main issues highlighted, and different anesthetic strategies considered. In conclusion, laser lead extraction in patients affected by CPVT can be performed safely under GA, provided that patients are cautiously treated and assessed during the whole perioperative period.