Anesthetic Management of a Patient for Total Gastrectomy after Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery

We report anesthetic management of total gastrectomy for gastric cancer under general anesthesia supplemented with a transversus abdominis plane (TAP) block. The patient was a 78-year-old man who had received coronary artery bypass grafting (CABG) with the right gastroepiploic artery (RGEA) 12 years before. Preoperative coronary angiography (CAG) showed that RCA was obstructed completely and RGEA was patent and the surgeons carried out gastrectomy with the utmost attention not to injure the RGEA. There were no signs of myocardial ischemia under monitoring by transesophageal echocardiography (TEE). The ultrasound-guided TAP block was effective. This case demonstrates that the ultrasound-guided TAP block is an alternative approach for providing analgesia and intraoperative TEE monitoring is useful in a patient with gastrectomy after CABG using the RGEA with coagulation abnormality.