Off-pump coronary artery grafting in awake patients with comorbidities using high thoracic epidural anesthesia

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.