Awake CABG on Beating Heart Under High Thoracic Epidural Anesthesia First Time in BSMMU

Abstract

Minimally invasive Coronary Artery Bypass Surgery (CABG) using Thoracic Epidural' Anesthesia (TEA) is nowadays considered to be a safe surgical strategy. The objective of TEA is to achieve somatosensory and motor block at TI to T8 level so that CABG can be done in - awake patient. In June 2006 when a 40 year old patient came to us in University Cardiac Centre (UCC) at BSMMU with double-vessel disease for CABG surgery, we considered it an opportunity to try this operation under only high thoracic epidural anesthesia without incubation. After taking the patient's consent, we proceeded to perform the awake CABG on beating heart (ACAS) - an operation attempted for the first time in BSMMU. The patient received TEA via an epidural catheter placed at the level of T1 -T2. Total arterial myocardial revascularization on was performed after sternotomy. The patient well tolerated all phases of the operation. Additional analgesics and sedatives required only during the sternotomy and sternal retraction. The patient's Blood Pressure (BP), SPO₂, ABG, ETCO₂, ECG, and all other parameters were within normal range throughout the whole procedure. The effect of movement of the chest wall and heart during spontaneous respiration did not affect the conduction of the surgery. The postoperative course was uneventful, and we were able to release the patient from the ICU on the second POD.

Journal of BSA, Vol. 20, No. 2, July 2007 p.70-72