Intraoperative Hypercapnia and Atrioventricular Block in a Robot-Assisted Renal Transplant: A Case Report
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Abstract
Robot-Assisted Kidney Transplantation (RAKT) is a minimally invasive alternative to open surgery, offering several benefits but posing anesthetic challenges related to pneumoperitoneum and patient positioning. These factors can compromise cardiorespiratory function and electrolyte balance. This case report discusses the anesthetic management of the first RAKT at the Philippine General Hospital, emphasizing the detection and treatment of intraoperative hypercapnia—an infrequent yet potentially serious complication that may result in acidosis, hyperkalemia, and arrhythmia.
[1] Spiers HVM, Sharma V, Woywodt A, Sivaprakasam R, Augustine T. Robot-assisted kidney transplantation: an update. Clin Kidney J. 2021; 15(4):635-43.
[2] Frongia M, Cadoni R, Solinas A. First robotic-assisted dual kidney transplant: surgical technique and report of a case with 24-month follow-up. Transplant Direct. 2015; 1(9):e34.
[3] Hsu RL, Kaye AD, Urman RD. Anesthetic challenges in robotic-assisted urologic surgery. Rev Urol. 2013; 15(4):178-84.
[4] Rajmohan N, Omkarappa S, Srinivasan SP, Nair SG, Rajgopal R, Eldo N. Anesthetic challenges and perioperative factors affecting delayed graft function in robotic-assisted kidney transplant: a review of a single-center experience of 100 cases. Cureus. 2022; 14(9):e28957.
[5] Chiumello D, Coppola S, Fratti I, Leone M, Pastene B. Ventilation strategy during urological and gynaecological robotic-assisted surgery: a narrative review. Br J Anaesth. 2023; 131(4):764-74.
[6] Song Z, Sun L, Chen P, Yu Y. Lung-protective ventilation strategy to improve oxygenation function and respiratory mechanics in patients undergoing robotic bariatric surgery: a randomized double-blind trial (CONSORT). Medicine (Baltimore). 2025; 104(6):e41433.
[7] Gaur P, Harde M, Gujjar P, Deosarkar D, Bhadade R. A study of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide correlation in intraoperative and postoperative period in neurosurgical patients. Asian J Neurosurg. 2017; 12(3):475-82.
[8] Barud M, Turek B, Dąbrowski W, Siwicka D. Anesthesia for robot-assisted surgery: a review. Anaesthesiol Intensive Ther. 2025; 57(1):99-107.
[9] Satoh K, Ohashi A, Kumagai M, Sato M, Kuji A, Joh S. Evaluation of differences between PaCO2 and ETCO2 by age as measured during general anesthesia with patients in a supine position. J Anesthesiol. 2015; 2015:710537.
[10] Weinberg L, Lee DK, Gan C, Ianno D, Ho A, Fletcher L, et al. The association of acute hypercarbia and plasma potassium concentration during laparoscopic surgery: a retrospective observational study. BMC Surg. 2021; 21(1):31.
[11] Perez GO, Oster JR, Vaamonde CA. Serum potassium concentration in acidemic states. Nephron. 1981; 27(4-5):233-43.
[12] Simon LV, Rout P. Hyperkalemia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Dec 1.
[13] Baratloo A, Haroutunian P, Rouhipour A, Safari S, Rahmati F. Hyperkalemia-induced complete heart block. J Emerg Pract Trauma. 2015; 1(1):35-8.
[14] Lee HJ, Chae JS, An SM, Oh HW, Kim YJ, Woo JH. Strategy to reduce hypercapnia in robot-assisted radical prostatectomy using transcutaneous carbon dioxide monitoring: a prospective observational study. Ther Clin Risk Manag. 2022; 18:249-58.
[15] Christie E, Okel J, Gowrishankar M. Hyperkalemia in the early post renal transplant period. Transplantation. 2018; 102:S597.
[2] Frongia M, Cadoni R, Solinas A. First robotic-assisted dual kidney transplant: surgical technique and report of a case with 24-month follow-up. Transplant Direct. 2015; 1(9):e34.
[3] Hsu RL, Kaye AD, Urman RD. Anesthetic challenges in robotic-assisted urologic surgery. Rev Urol. 2013; 15(4):178-84.
[4] Rajmohan N, Omkarappa S, Srinivasan SP, Nair SG, Rajgopal R, Eldo N. Anesthetic challenges and perioperative factors affecting delayed graft function in robotic-assisted kidney transplant: a review of a single-center experience of 100 cases. Cureus. 2022; 14(9):e28957.
[5] Chiumello D, Coppola S, Fratti I, Leone M, Pastene B. Ventilation strategy during urological and gynaecological robotic-assisted surgery: a narrative review. Br J Anaesth. 2023; 131(4):764-74.
[6] Song Z, Sun L, Chen P, Yu Y. Lung-protective ventilation strategy to improve oxygenation function and respiratory mechanics in patients undergoing robotic bariatric surgery: a randomized double-blind trial (CONSORT). Medicine (Baltimore). 2025; 104(6):e41433.
[7] Gaur P, Harde M, Gujjar P, Deosarkar D, Bhadade R. A study of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide correlation in intraoperative and postoperative period in neurosurgical patients. Asian J Neurosurg. 2017; 12(3):475-82.
[8] Barud M, Turek B, Dąbrowski W, Siwicka D. Anesthesia for robot-assisted surgery: a review. Anaesthesiol Intensive Ther. 2025; 57(1):99-107.
[9] Satoh K, Ohashi A, Kumagai M, Sato M, Kuji A, Joh S. Evaluation of differences between PaCO2 and ETCO2 by age as measured during general anesthesia with patients in a supine position. J Anesthesiol. 2015; 2015:710537.
[10] Weinberg L, Lee DK, Gan C, Ianno D, Ho A, Fletcher L, et al. The association of acute hypercarbia and plasma potassium concentration during laparoscopic surgery: a retrospective observational study. BMC Surg. 2021; 21(1):31.
[11] Perez GO, Oster JR, Vaamonde CA. Serum potassium concentration in acidemic states. Nephron. 1981; 27(4-5):233-43.
[12] Simon LV, Rout P. Hyperkalemia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Dec 1.
[13] Baratloo A, Haroutunian P, Rouhipour A, Safari S, Rahmati F. Hyperkalemia-induced complete heart block. J Emerg Pract Trauma. 2015; 1(1):35-8.
[14] Lee HJ, Chae JS, An SM, Oh HW, Kim YJ, Woo JH. Strategy to reduce hypercapnia in robot-assisted radical prostatectomy using transcutaneous carbon dioxide monitoring: a prospective observational study. Ther Clin Risk Manag. 2022; 18:249-58.
[15] Christie E, Okel J, Gowrishankar M. Hyperkalemia in the early post renal transplant period. Transplantation. 2018; 102:S597.
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| Section | Case Report(s) | |
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| Robot-Assisted Kidney Transplantation Hypercapnia General Anesthesia | ||
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How to Cite
1.
Solomon LM, Odi AN. Intraoperative Hypercapnia and Atrioventricular Block in a Robot-Assisted Renal Transplant: A Case Report. Arch Anesth & Crit Care. 2026;.
