Resurfacing of awake coronary artery bypass grafting with mid thoracic epidural anesthesia technique

Awake coronary artery bypass grafting (CABG) is increasingly becoming recognized as a feasible alternative for high-risk cardiac patients, with a potential to reduce perioperative morbidity. In light of this, high thoracic epidural anesthesia (HTEA) has been used for cardiac surgery over the past two decades, providing excellent analgesia and sympathetic blockade. In this case report, a 71-year-old patient with interstitial lung disease (ILD) on home oxygen treatment had successful awake CABG at our institute, using a combined mid-thoracic and lumbar epidural approach. This method offered effective segmental anesthesia and analgesia, ensuring patient comfort and hemodynamic stability throughout the surgery. In comparison to HTEA, the mid-thoracic epidural approach provided better control of anesthesia and analgesia, minimized the risk of high sympathetic blockade, and facilitated early postoperative recovery with minimum opioid usage and early mobilization without any intraoperative or postoperative complications. This case emphasizes the feasibility and potential advantages of combined mid-thoracic and lumbar epidural anesthesia over high thoracic epidural in selected high-risk patients undergoing awake CABG.