Coronary Artery Bypass Surgery in "Awake" Patient: A Prospective Study

Background: Advances in cardiac surgery and anesthesia are meant to give better outcomes and faster recovery for the patients. As the rate of success of coronary bypass surgery has been standardized over the years, we are presently attempting to improve early recovery which directly helps in early rehabilitation. Aim: To see the feasibility of awake cardiac surgery under epidural anesthesia. Single tertiary care medical center. Prospective, randomized, non-blinded clinical study. 10 patients scheduled for awake off-pump coronary artery bypass surgery. Subjects and Methods: In selected 10 patients epidural catheter was inserted between C7-T3 inter-vertebral spaces 1 day prior to surgery. On the day of surgery, epidural anesthesia was given with bolus dose of 0.05 ml/cm of height of patient of 0.5% bupivacaine and 100 mu g of fentanyl. After assessing the level of block, continuous infusion of 0.5% bupivacaine at 3 ml/h was started, and infusion rate was adjusted according to the requirement. Post-operative analgesia was maintained with continuous infusion of 0.125% bupivacaine 4-14 ml/h according to pain score. The epidural catheter was left in-situ for 48 h and removed. Result: Thoracic epidural anesthesia (TEA) without intubation was used in 10 patients undergoing off-pump coronary artery bypass graft surgery, performed successfully through a median sternotomy. The mean surgical time was 113.5 min; average intravenous fluid infusion was 595 ml, one patient required nor-adrenaline infusion during surgery. The requirement of epidural infusion intra-operative and post-operative period was 20 ml and 276 ml, respectively. All patients had an uneventful postoperative course. Conclusion: The study shows that awake cardiac surgery using only TEA without general anesthesia is feasible and safe.