Target-controlled infusion without neuromuscular blockade for robotic prostatectomy in an adult with a right-sided Bochdalek hernia

Adult presentation of Bochdalek hernia is rare and often detected incidentally. Herniation of abdominal viscera into the thoracic cavity significantly alters respiratory mechanics and cardio-mediastinal dynamics. These effects pose considerable anaesthetic challenges during procedures requiring pneumoperitoneum and steep Trendelenburg positioning, such as robotic pelvic surgery. We report the anaesthetic management of an elderly male with a large right-sided Bochdalek hernia undergoing robotic radical prostatectomy. Given the risk of further diaphragmatic displacement and cardiopulmonary compromise, a non-neuromuscular blockade technique was employed using target-controlled infusions of propofol and remifentanil. Adequate surgical conditions were achieved while preserving diaphragmatic tone and maintaining stable respiratory and hemodynamic parameters throughout pneumoperitoneum and Trendelenburg positioning. This case illustrates the importance of individualized anaesthetic planning in patients with significant diaphragmatic pathology. Target-controlled infusion-based anaesthesia without neuromuscular blockade can provide satisfactory surgical conditions while mitigating the physiological risks associated with altered thoracoabdominal mechanics.