Off-pump coronary artery grafting in awake patients with comorbidities using high thoracic epidural anesthesia | ||||
| The Egyptian Journal of Cardiothoracic Anesthesia | ||||
| Volume 13, Issue 1, January 2019 PDF (84.45 K) | ||||
| DOI: 10.4103/ejca.ejca_16_18 | ||||
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| Authors | ||||
| Ahmed S. Mahmoud; Passaint M. Fahim | ||||
| Abstract | ||||
| Background General anesthesia (GA) can be itself an obstacle to some patients with comorbidities to operate upon a mandatory cardiac surgery. Patients and methods Between January 2013 and May 2017 in the Cardiothoracic Surgery Department, Cairo University Hospitals; 31 patients of awake ‘off-pump’ (without cardiopulmonary bypass) coronary bypass surgery were performed by sternotomy, facilitated by thoracic epidural anesthesia. Analgesia was provided with thoracic epidural anesthesia at T2–3 interspace, using bupivacaine 0.5%, lidocaine 2%, and fentanyl 2 μg/ml until T1–8 dermatomal block was achieved, and then was maintained at 8–12 ml/h throughout the surgery. Success of awake off-pump coronary artery bypass grafting, without GA with appropriate surgical and medical conditions, was the target of the study. Results Thirty-one patients (range, 50–70 years) median, 61 years, weight (range, 70–109 kg) median, 78 kg, underwent surgery. Five (16%) patients needed conversion to GA: the left internal mammary artery was dissected, a saphenous vein graft was needed instead. Awake surgery was successful without complications in 68% of cases. Conclusions Off-pump coronary artery bypass grafting in awake old patients can be considered a safe and feasible technique with convenient surgical outcome especially in patients who cannot tolerate GA. | ||||
| Keywords | ||||
| Awake; comorbidities; off-pump heart surgery | ||||
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