Awake partial sternotomy pacemaker implantation under thoracic epidural anesthesia.

Area of Science:

• Cardiology
• Anesthesiology
• Thoracic Surgery

Background:

• Severe obstructive pulmonary disease contraindicates general anesthesia for cardiac procedures.
• Symptomatic bradycardia and tricuspid vegetation due to infective endocarditis necessitate intervention.

Observation:

• An 82-year-old male patient with severe pulmonary dysfunction required epicardial pacemaker implantation.
• Standard endotracheal general anesthesia was deemed high-risk.

Findings:

• Thoracic epidural anesthesia at the T5/6 level facilitated a lower partial sternotomy for dual pacing electrode placement.
• The patient maintained spontaneous breathing and adequate oxygenation throughout the awake cardiac surgery.
• The postoperative recovery was uneventful, with no complications.

Implications:

• Awake cardiac surgery under thoracic epidural anesthesia is a viable, less invasive alternative for high-risk patients.
• This technique enables essential cardiac procedures in individuals with significant pulmonary limitations.
• Epicardial pacemaker implantation can be safely performed using this anesthetic approach.