Conscious cardiac surgery with cardiopulmonary bypass using thoracic epidural anesthesia without endotracheal general anesthesia.
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.


METHODS
A prospective study.


METHODS
Tertiary referral heart hospital.


METHODS
Eleven patients underwent cardiac surgical procedures requiring cardiopulmonary bypass under thoracic epidural anesthesia from February to April 2004.


METHODS
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.


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.


CONCLUSIONS
Cardiac surgical procedures requiring cardiopulmonary bypass may be performed under thoracic epidural anesthesia, without endotracheal general anesthesia.
Chakravarthy
Murali
M
Wockhardt Heart Institute, Bangalore, Karnataka, India. chakravarthy@vsnl.com
Jawali
Vivek
V
Patil
Thimmannagowda A
TA
Jayaprakash
Krishnamoorthy
K
Kolar
Srinivasan
S
Joseph
Gilbert
G
Das
Jayant Kumar
JK
Maheswari
Uma
U
Sudhakar
Nachu
N
D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General; D001784:Blood Gas Analysis / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors