[Anesthetic management of awake coronary artery bypass grafting using dexmedetomidine--high-dose administration and pharmacokinetic simulation].

We experienced anesthetic management using dexmedetomidine for awake coronary artery bypass grafting (ACAB) in a patient with cerebrovascular and lung diseases. Epidural anesthesia was performed using only local anesthetics, and narcotics were not administered for epidural anesthesia or general anesthesia. The patient complained of discomfort when the surgical maneuver reached the superior extremity of the sternum and when pneumothorax occurred. Pain during the surgical maneuver was relieved by bolus infusion of dexmedetomide 0.1 microg x kg(-1) in addition to injection of a local anesthetic and infusion of a local anesthetic by an epidural catheter. SpO2 decreased to 94% until suturing of the pleura, but the patient did not complain of dyspnea when the rate of continuous infusion of dexmedetomidine was increased to 1.4 microg x kg(-1) x h(-1). Hemodynamics was stable in the intraoperative period, although the plasma concentration of dexmedetomidine calculated by pharmacokinetic simulation analysis, exceeded 1.6 ng x ml(-1). Aggravation of cerebrovascular or lung disease did not occur in the perioperative period. Dexmedetomidine may be useful for ACAB.