Roles of Nurse Anesthetists in Caring for Patients Undergoing Robot-Assisted Nephrectomy

Abstract

Currently, robot-assisted nephrectomy is increasingly important in the medical field.Nurse anesthetists, as part of the anesthesia team, play a crucial role in patient care during robotic nephrectomy. This surgical method offers clear advantages, including smaller incisions, faster patient recovery, reduced pain, reduced blood loss, and fewer potential surgical complications.This article presents practice guidelines for preoperative, intraoperative, and postoperative care of patients undergoing robotic-assisted nephrectomy, enabling nurse anesthetists, anesthesiologists,and other relevant medical personnel to perform their duties efficiently and safely.

Robot-assisted nephrectomy differs significantly from conventional nephrectomy in several aspects. In the preoperative period, the preparation includes patient positioning, airway management, and intraoperative operating room management. The robotic system requires multiple mechanical arms positioned around the patient, which restricts the anesthetic team's workspace.Careful preoperative planning is essential for airway and venous access. Additionally, patient positioning in the lateral decubitus position with table flexion is crucial for expanding the operative field and facilitating surgical access. Securing the patient's hips and chest to the operating table to prevent movement, along with the use of padding to minimize nerve and soft-tissue injuries, are critical components. Furthermore, carbon dioxide insufflation affects the respiratory and circulatory systems; therefore, the anesthesia care team necessitates a deep understanding of physiological changes to plan anesthetic management appropriately.

During surgery, nurse anesthetists play a vital role in continuously monitoring the patient's vital signs to minimize cardiovascular complications.  They are also responsible for fluid management to maintain hemodynamic stability and kidney function, and the use of non-depolarizing muscle relaxants to ensure optimal muscle relaxation and prevent unwanted movements.

Postoperatively, nurse anesthetists are responsible for comprehensive monitoring of recovery from anesthesia, including checking vital signs every five minutes during the first hour and every 15 minutes thereafter until stability is achieved. They must also monitor for complications, such as subcutaneous carbon dioxide accumulation, by assessing oxygen saturation, respiratory rate, and lung sounds, and by observing for numbness in the patient's extremities. Also, pain levels must be continuously assessed using a Numeric Pain Rating Scale, ranging from 0 (no pain) to 10 (the worst imaginable pain), along with monitoring for additional complications such as nausea and vomiting.

Comprehensive care roles by nurse anesthetists throughout all phases of management not only enhance patient safety and surgical success but also promote the delivery of high-quality care and support the effective and safe use of robotic technology.

Keywords: Anesthesia, Anesthesia services, Robotic-assisted nephrectomy, Nurse anesthetists

Author Contribution

LP: Conceptualization, Literature review, and Writing – original draft.