Abstract

Background: Nano-robotic neurosurgical procedures represent a frontier in minimally invasive surgery, offering unprecedented precision in treating neurological disorders. These procedures introduce unique anesthetic challenges that require tailored approaches to ensure patient safety and procedural success.

Aim: This review explores key anesthetic considerations for nano-robotic neurosurgery, focusing on strategies to optimize patient outcomes

Issue: Anesthetic management prioritizes stable hemodynamics and intracranial pressure (ICP) to optimize the surgical field and protect neural structures. General anesthesia using total intravenous anesthesia (TIVA), using agents like propofol and remifentanil, is preferred for rapid titration and minimal impact on cerebral blood flow. Intraoperative neuromonitoring is employed for real-time neural function assessment, avoiding neuromuscular blockers that may interfere with signal accuracy. Protocols accommodate prolonged procedure times, patient immobility for nano-robot precision, and monitoring for potential thermal or mechanical neural irritation causing seizures or autonomic responses.

Conclusion: Nano-robotic neurosurgery demands specialized anesthetic protocols to address challenges such as stable hemodynamics, ICP control, and neuromonitoring compatibility. Effective collaboration between anesthesiologists, neurosurgeons, and nano-robotics engineers is critical to ensure patient safety and procedural success. Postoperative care emphasizes early neurological assessment and balanced pain management to support rapid recovery in this evolving field

• 1.   Marcus HJ, Vakharia VN, Ourselin S, Duncan J, Tisdall M, Aquilina K. Robot-assisted stereotactic brain biopsy: systematic review and bibliometric analysis. Childs Nerv Syst. 2018;34(7):1299-309. doi: 10.1007/s00381-018-3821-y.
• 2.   Kajita Y, Nakatsubo D, Kataoka H, Nagai T, Nakura T, Wakabayashi T. Installation of a Neuromate robot for stereotactic surgery: efforts to conform to Japanese specifications and an approach for clinical use—technical notes. Neurol Med Chir (Tokyo). 2015;55(12):907-14. doi: 10.2176/nmc.tn.2015-0043.
• 3.   Liu L, Mariani SG, De Schlichting E, Grand S, Lefranc M, Seigneuret E, Chabardès S. Frameless ROSA® robot-assisted lead implantation for deep brain stimulation: technique and accuracy. Oper Neurosurg. 2020;19(1):57-64. doi: 10.1093/ons/opz320.
• 4.   Giridharan N, Katlowitz KA, Anand A, Gadot R, Najera RA, Shofty B, et al. Robot-assisted deep brain stimulation: high accuracy and streamlined workflow. Oper Neurosurg. 2022;23(3):254-60. doi: 10.1227/ons.0000000000000298.
• 5.   Palmisciano P, Miranda R, Ling GSF, Draghic N. Nanorobotics for neurosurgery. In: Kateb B, Heiss JD, Yu JS, Hsieh M, editors. The Textbook of Nanoneuroscience and Nanoneurosurgery. Cham: Springer; 2024. doi: 10.1007/978-3-030-80662-0_34.
• 6.   Li J, Esteban-Fernández de Ávila B, Gao W, Zhang L, Wang J. Micro/nanorobots for biomedicine: delivery, surgery, sensing, and detoxification. Sci Robot. 2017;2(4):eaam6431. doi: 10.1126/scirobotics.aam6431.
• 7.   Hii ARK, Qi X, Wu Z. Advanced strategies for CRISPR/Cas9 delivery and applications in gene editing, therapy, and cancer detection using nanoparticles and nanocarriers. J Mater Chem B. 2024;12(6):1467-89.
• 8.   Kong X, Gao P, Wang J, Fang Y, Hwang KC. Advances of medical nanorobots for future cancer treatments. J Hematol Oncol. 2023;16(1):74. doi: 10.1186/s13045-023-01463-z.
• 9.   Khan Z, Khan N, Geetha M, et al. Therapeutic applications of nanobots and nanocarriers in cancer treatment. Anal Sci. 2025;41(8):1305-24. doi: 10.1007/s44211-025-00799-5.
• 10.   Sharma KK, Reddy KRM. Exploratory modeling of intraoperative co-oximetry data for predicting hemodynamic trends in a thalassemic patient: a pilot case. J Neuroanaesthesiol Crit Care. 2025;12(3). [Epub ahead of print]. doi: 10.1055/s-0045-1810607.
• 11.   Kumar K, Gopalakrishna KN. Predictive modeling of intraoperative SSEP during ACOM aneurysm clipping - a case based simulation study. In: Abstracts From the 53rd Annual Meeting of the Society for Neuroscience in Anesthesiology and Critical Care; 2025 Sep 12-14. J Neurosurg Anesthesiol. 2026;38(1):e1-57.
• 12.   Zhou H, Mayorga-Martinez CC, Pané S, Zhang L, Pumera M. Magnetically driven micro and nanorobots. Chem Rev. 2021;121(8):4999-5041. doi: 10.1021/acs.chemrev.0c01234.
• 13.   Sharma KK, Sharma P, Surve RM. Cerebral oxygenation monitoring for early detection of subarachnoid haemorrhage in infratentorial arteriovenous malformation undergoing embolisation: a case study. Indian J Anaesth. 2024;68(2):206-8. doi: 10.4103/ija.ija_716_23.
• 14.   Giergiel M. Certain problems in the development of nanorobots. Online J Robot Autom Technol. 2024;2(5):1-2. doi: 10.33552/OJRAT.2024.02.000547.

Data Sharing Statement

Funding