Awake partial sternotomy pacemaker implantation under thoracic epidural anesthesia.
An 82-year-old man with symptomatic bradycardia had infective endocarditis with tricuspid vegetation. The patient also had severe obstructive pulmonary disease, and endotracheal general anesthesia was contraindicated. Under satisfactory epidural anesthesia with catheterization at the T5/6 level, lower partial sternotomy was performed, and dual pacing electrodes were placed on the heart. Throughout the surgery, spontaneous breathing was maintained with a sufficient level of oxygenation. The postoperative course was uneventful. Although awake cardiac surgery under thoracic epidural anesthesia is challenging, this less invasive technique was useful for epicardial pacemaker implantation in this patient with severe pulmonary dysfunction.
Department of Cardiovascular Surgery, Niigata City General Hospital, 2-6-1 Shichikuyama, Niigata, 950-8739, Japan. kenjitcs@gmail.com
Kenji
K
Aoki
Hiroshi
H
Kanazawa
Takeshi
T
Okamoto
Yoshiki
Y
Takahashi
Satoshi
S
Nakazawa
Yoshihiko
Y
Yamazaki
D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003243:Consciousness; D020878:Device Removal; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012086:Reoperation; D012720:Severity of Illness Index; D012804:Sick Sinus Syndrome / Q000150:complications / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification; D056346:Sternotomy