Awake coronary artery bypass grafting under thoracic epidural anesthesia: great impact on off-pump coronary revascularization and fast-track recovery.

OBJECTIVE

The ultimate goal of minimally invasive coronary artery bypass grafting (CABG) is day surgery. We evaluated the potential of a new awake CABG protocol using only epidural anesthesia in realizing day surgery.

METHODS

Seventy-two patients who underwent awake off-pump CABG (OPCAB) in our institute from March 2003 were studied. One day before surgery, an epidural catheter was placed at the Th1-2 interspace. On the day of surgery, local anesthetics were delivered via the catheter to provide a level of epidural block from C6 to Th8. Among 1260 patients who underwent OPCAB under general anesthesia (GA) during this study period, 67 of them who matched for age and gender with the awake OPCAB group were selected as controls (GA group). Postoperative fast-track recovery was evaluated.

RESULTS

In 67 of the 72 patients (93%), awake OPCAB under consciousness and spontaneous breathing was fully accomplished. Five patients had to be administered GA. Ten patients (14.9%) were able to leave the operating room in a wheelchair. The time to drink water, the time to walk, and hospital stay were significantly shorter in awake OPCAB group than in the GA group. There were no operative and postoperative complications or deaths.

CONCLUSIONS

Despite the presence of severe preoperative comorbidities in this series, good surgical outcome was obtained. Almost all the patients were able to drink water and walk very soon after surgery, suggesting the potential of this protocol as one-day or day surgery. Awake OPCAB is a promising modality of ultra-minimally invasive cardiac surgery.