Awake cardiac surgery using a novel anesthetic technique

We describe the first published cases of awake cardiac surgery in Canada. In addition, a novel anesthetic technique consisting of combined femoral block/high epidural thoracic anesthesia is presented. Two patients, both 65 yr of age and with good left ventricular function, were scheduled to undergo...

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Bibliographic Details
Published in:Canadian journal of anesthesia 2005-12, Vol.52 (10), p.1088-1092
Main Authors: HEMMERLING, Thomas M, NOISEUX, Nicolas, BASILE, Fadi, NOEL, Marie-Frédérique, PRIETO, Ignatio
Format: Article
Language:English
Subjects:
Aged
Anesthesia
Anesthesia, Epidural
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiac Surgical Procedures
Coronary Artery Bypass, Off-Pump
Echocardiography
Femoral Nerve
Hemodynamics - physiology
Humans
Male
Mammary Arteries - transplantation
Medical sciences
Monitoring, Intraoperative
Nerve Block
Respiratory Function Tests
Saphenous Vein - transplantation
Stents
Stroke Volume - physiology
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Summary:We describe the first published cases of awake cardiac surgery in Canada. In addition, a novel anesthetic technique consisting of combined femoral block/high epidural thoracic anesthesia is presented. Two patients, both 65 yr of age and with good left ventricular function, were scheduled to undergo off-pump coronary artery bypass grafting (OPCAB) for two grafts each. Anesthesia consisted of combined femoral 3:1 block and high thoracic epidural anesthesia. Both surgeries proceeded without hemodynamic or respiratory complications; in both cases, opening of the pleural spaces was treated with insertion of thoracic drainage tubes. Both patients were transferred to the postanesthesia care unit immediately after surgery and six hours later to the cardiac surgical ward. Both patients were discharged from the hospital within five days of surgery. We conclude that awake OPCAB is feasible using a combined femoral block/high thoracic epidural anesthesia technique which allows cardiac surgery and harvesting of the saphenous vein. Further clinical experience is required to define the technical limitations of this technique before randomized studies should be undertaken to better define the role of awake procedures in the future of cardiac surgery.
ISSN:0832-610X
1496-8975
DOI:10.1007/BF03021610