[Total arterial bypass operations with complete sternotomy in the awake patient].
BACKGROUND
In minimally invasive coronary artery bypass surgery beating heart procedures and operations via limited incisions became more popular and are routinely performed in many centers. An additional approach to minimize general trauma is avoidance of general anesthesia endotracheal intubation.


METHODS
Between March and June 2001, 14 spontaneously breathing patients underwent coronary artery bypass grafting on the beating heart without general anesthesia. Intra- and postoperative analgesia management was performed using continuous epidural infusion of local anesthetics at level Th2-Th3. Single (n = 8) as well as double (n = 5) and triple (n = 1) bypass grafting was performed with the off pump technique. Surgical access to the chest cavity was created via partial (n = 8) or complete sternotomy (n = 6).


RESULTS
Twelve patients remained awake throughout the procedure; 2 patients required secondary intubation due to incomplete sensory block and pneumothorax. Operating time was 94 +/- 18 minutes. Intermediate care monitoring time amounted to 4.8 +/- 0.6 hours. No surgery-related complications or myocardial infarction occurred. Postoperative angiography reviewed good graft function in all patients.


CONCLUSIONS
Our preliminary experience shows that complete surgical revascularization is safe and feasible without endotracheal intubation and general anesthesia. Thus, invasiveness in cardiac surgery is further reduced with less need for intensive care unit monitoring enabling faster mobilization and recovery.
Aybek
T
T
Klinik für Thorax-, Herz- und thorakale Gefässchirurgie Johann-Wolfgang-von-Goethe-Universität Frankfurt/Main Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany. T.Aybek@em.uni-frankfurt.de
Dogan
S
S
Kessler
P
P
Neidhart
G
G
Khan
M F
MF
Wimmer-Greinecker
G
G
Moritz
A
A
D000368:Aged; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009203:Myocardial Infarction / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D013249:Sternum / Q000601:surgery*