Practice in anesthesia: intrathecal morphine for off pump coronary artery bypass graft

Off pump coronary artery bypass grafting is gaining popularity because of its beneficial effects like reduced inflammatory response, early extubation, reduced hospital & ICU stay, less homologous blood transfusion & reduced cost. Here we report a case of left anterior descending artery blockade who had undergone off pump coronary artery bypass grafting. In this case we used intrathecal morphine with heavy bupivcaine to provide intraoperative as well as post operative analgesia. Though intrathecal morphine has been used as analgesia in cardiac surgeries, the use of intrathecal morphine with bupivacaine is less reported. It not only provides intense analgesia which helps for early extubation & hemodynamic stability but also provides calm & quiet surgical field with slow beating heart & aids in critical time of vessel anastomosis. We have also discussed the other aspects of anesthetic management with little elaboration in surgical aspect as well.