Conscious off-pump coronary artery bypass surgery

Area of Science:

• Cardiology
• Anesthesiology
• Thoracic Surgery

Background:

• Thoracic epidural anesthesia has been previously used successfully in cardiothoracic surgery.
• This study explored epidural anesthesia as the sole anesthetic for conscious off-pump coronary artery bypass surgery.
• The technique offers an alternative to general anesthesia in cardiac procedures.

Purpose of the Study:

• To evaluate the feasibility and outcomes of conscious coronary artery bypass surgery using epidural anesthesia as the sole anesthetic.
• To demonstrate that modifications in surgical techniques can facilitate this procedure.

Main Methods:

• 123 patients underwent off-pump coronary artery bypass surgery with epidural anesthesia as the sole anesthetic between October 2001 and December 2003.
• Epidural catheters were placed the evening before surgery.
• Surgical approaches included left thoracotomy and mid sternotomy.

Main Results:

• 120 out of 123 patients successfully underwent off-pump coronary artery bypass graft surgery.
• A total of 295 grafts were performed across all patients.
• Three patients required conversion to general anesthesia, and one to cardiopulmonary bypass, with no mortality observed.

Conclusions:

• Conscious coronary artery bypass surgery is achievable with modified surgical techniques.
• Epidural anesthesia as the sole anesthetic is a safe and effective option for selected patients undergoing off-pump coronary artery bypass.
• This approach provides a valuable alternative for cardiac surgery patients.