Conscious Cardiac Surgery With Cardiopulmonary Bypass Using Thoracic Epidural Anesthesia Without Endotracheal General Anesthesia

• Published in: Journal of cardiothoracic and vascular anesthesia 2005-06, Vol.19 (3), p.300-305
• Main Authors: Chakravarthy, Murali, Jawali, Vivek, Patil, Thimmannagowda A., Jayaprakash, Krishnamoorthy, Kolar, Srinivasan, Joseph, Gilbert, Das, Jayant Kumar, Maheswari, Uma, Sudhakar, Nachu
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia, Epidural - methods; Anesthesia, General; Blood Gas Analysis - methods; cardiac surgery; Cardiac Surgical Procedures - methods; cardiopulmonary bypass; Cardiopulmonary Bypass - methods; conscious patient; Conscious Sedation - methods; Feasibility Studies; Female; Hemodynamics - physiology; Humans; Intubation, Intratracheal; Male; Middle Aged; Monitoring, Intraoperative - methods; Prospective Studies; thoracic epidural anesthesia; Time Factors
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2005.03.005

Objective: The purpose of this study was to evaluate the feasibility of thoracic epidural anesthesia as an alternative technique to general anesthesia in patients undergoing cardiac surgery under cardiopulmonary bypass. Design: A prospective study. Setting: Tertiary referral heart hospital. Participants: Eleven patients underwent cardiac surgical procedures requiring cardiopulmonary bypass under thoracic epidural anesthesia from February to April 2004. Interventions: An epidural catheter was inserted at C7 to T2 intervertebral space on the day before the operation. Subsequently, cardiac surgery was performed using cardiopulmonary bypass. Measurements and Results: The midsternotomy approach was used in all the patients. Anticoagulation was achieved with 300 units/kg of heparin. Under normothermic cardiopulmonary bypass, 6 patients underwent closure of atrial septal defect, 3 underwent valve replacements, and 2 underwent coronary artery bypass surgery combined with valve replacements. Soon after establishing cardiopulmonary bypass, all but 1 patient developed apnea, which was reversed after termination of cardiopulmonary bypass. The mean cardiopulmonary bypass time was 102 ± 28 minutes, the aortic cross-clamp time was 58 ± 28 minutes, and the total duration of surgery was 229 ± 64 minutes. There was no mortality or morbidity in this series. Conclusion: Cardiac surgical procedures requiring cardiopulmonary bypass may be performed under thoracic epidural anesthesia, without endotracheal general anesthesia.