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Awake cardiac surgery using a novel anesthetic technique

[Une nouvelle technique anesthésique pour la chirurgie cardiaque vigile]

Thomas M. Hemmerling, md deaa^*, Nicolas Noiseux, md frcsc msc, Fadi Basile, md frcsc, Marie-Frédérique Noël, md and Ignatio Prieto, md frcsc

^* From the PeriCARG (Perioperative Cardiac Research Group), Departments of Anesthesiology, and
Cardiac Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Hôtel-Dieu, Université de Montréal, Montréal, Québec, Canada.

Address correspondence to: Dr. Thomas M. Hemmerling, Centre Hospitalier de l’Université de Montréal (CHUM), Hôtel-Dieu, Université de Montréal, 3840, rue Saint-Urbain, Montréal, Québec H2W 1T8, Canada. Phone: 514-890-8000, ext. 14570; Fax: 514-412-7222; E-mail: thomashemmerling{at}hotmail.com

Purpose: We describe the first published cases of awake cardiac surgery in Canada. In addition, a novel anesthetic technique consisting of combined femoral block/high epidural thoracic anesthesia is presented.

Clinical features: Two patients, both 65 yr of age and with good left ventricular function, were scheduled to undergo off-pump coronary artery bypass grafting (OPCAB) for two grafts each. Anesthesia consisted of combined femoral 3:1 block and high thoracic epidural anesthesia. Both surgeries proceeded without hemodynamic or respiratory complications; in both cases, opening of the pleural spaces was treated with insertion of thoracic drainage tubes. Both patients were transferred to the postanesthesia care unit immediately after surgery and six hours later to the cardiac surgical ward. Both patients were discharged from the hospital within five days of surgery.

Conclusion: We conclude that awake OPCAB is feasible using a combined femoral block/high thoracic epidural anesthesia technique which allows cardiac surgery and harvesting of the saphenous vein. Further clinical experience is required to define the technical limitations of this technique before randomized studies should be undertaken to better define the role of awake procedures in the future of cardiac surgery.

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