High thoracic epidural anesthesia as the sole anesthetic for performing multiple grafts in off-pump coronary artery bypass surgery

OBJECTIVES: The feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing beating heart coronary revascularization avoiding general anesthesia was studied. DESIGN: A prospective study. SETTING: A tertiary care medical center. INTERVENTIONS: Fifteen patients underwent beating heart coronary artery revascularization without endotracheal general anesthesia, between October 2001 to May 2002, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. MEASUREMENTS AND MAIN RESULTS: The patients received 36 grafts (single, n = 5; double, n = 3; triple, n = 3; quadruple, n = 4). There were 3 female patients and 12 male patients with mean age of 60.6 +/- 5.9 years. Two patients underwent repeat coronary artery bypass. All the patients underwent off-pump coronary artery bypass graft surgery; 2 patients underwent grafting via left thoracotomy and the rest through a midsternotomy. There was no conversion to general anesthesia or cardiopulmonary bypass, and there was no mortality. Mean length of stay in the intensive care unit was 18.2 +/- 4.2 hours and in the hospital was 3.2 +/- 1.2 days. CONCLUSION: Experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia.