Coronary artery bypass grafting in the conscious patient without endotracheal general anesthesia

Background. Over the past several years, considerable experience has accumu lated in performing coronary anastomoses on the beating heart, and various aspects of minimally invasive approaches have been simplified. In an attemp t to further simplify and decrease the "invasiveness" of this procedure, pe rforming this operation without endotracheal general anesthesia was deemed feasible in certain subsets of patients. Methods. Between October 1998 and June 1999, 5 patients underwent coronary artery bypass grafting without endotracheal general anesthesia, using high thoracic epidural block to construct extension grafts with a short segment of radial artery, between the in situ left or right internal thoracic arter ies and the left anterior descending (n = 4) or right coronary arteries (n = 1). There were 2 female and 3 male patients, with a mean age of 67.4 +/- 8.3 years. Results. The perioperative course of the patients was uneventful. There was no perioperative morbidity or mortality. No patient was converted to gener al anesthesia or to conventional operation. Control angiograms revealed pat ent anastomoses in all patients. In 1 patient, spasm of the radial artery g raft was observed that was relieved 3 weeks later spontaneously. Mean lengt h of hospital stay was 2.2 +/- 0.4 days. All patients were symptom free and returned to normal daily life at the first postoperative month. Conclusions. Our initial experience confirms the feasibility of performing coronary bypass grafting in the conscious patient without endotracheal gene ral anesthesia. (Ann Thorac Surg 2000;70:91-6) (C) 2000 by The Society of T horacic Surgeons.