Awake coronary artery bypass grafting under thoracic epidural anesthesia: great impact on off-pump coronary revascularization and fast-track recovery

Watanabe, Go; Tomita, Shigeyuki; Yamaguchi, S; Yashiki, Noriyoshi

doi:10.1016/j.ejcts.2011.01.034

Cited by 16 publications

(15 citation statements)

References 15 publications

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“…They further reported the results of awake OPCAB in 72 patients and compared them with matched patients under general anesthesia. 15) Fifteen percent of the awake patients were able to leave the operating room in a wheelchair. The time taken to drink water and to walk and the duration of hospital stay were reported to be significantly shorter in the awake OPCAB group than in the general anesthesia group.…”

Section: Awake Opcabmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Doi

Okawa

2013

ATCS

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Off-pump coronary artery bypass grafting (OPCAB) is performed in about 65% of patients who require surgical coronary revascularization, and has become the standard procedure in coronary artery bypass grafting (CABG) in Japan. As a background of the high rate of OPCAB, many clinical and experimental studies have been performed and reported in Japan. In this review, several factors associated with OPCAB are discussed based on relevant and important clinical studies published in Japan in the English language.

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Section: Awake Opcabmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Doi

Okawa

2013

ATCS

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“…[5][6][7] In order to reduce the adverse effects of general anesthesia and the cost, TEA has been employed to perform such awake thoracic surgery procedures. AOCAB is a novel intraoperative or perioperative management technique.…”

Section: Discussionmentioning

confidence: 99%

“…5 We have also performed AOCAB under thoracic epidural anesthesia (TEA) in such high-risk patients with a history of cerebral infarction or impaired cerebral blood flow or severe pulmonary dysfunction since 2003. 6 In AOCAB, general anesthesia or tracheal intubation are unnecessary because spontaneous breathing can be maintained by high TEA alone. Thus cerebrovascular data can be collected from conscious patients that enables effective monitoring.…”

Section: Introductionmentioning

confidence: 99%

Monitoring brain oxygen saturation during awake off-pump coronary artery bypass

Toda

Watanabe

Matsumoto

et al. 2013

Asian Cardiovasc Thorac Ann

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Objective: To evaluate the changes in cerebral blood flow during awake off-pump coronary artery bypass grafting and compare with the changes during off-pump coronary artery bypass grafting under general anesthesia, using continuous monitoring of regional cerebral oxygen saturation.Methods: The study population comprised 3 groups of patients who had undergone off-pump coronary artery bypass grafting with thoracic epidural anesthesia, general anesthesia, or a combination of the two. Regional brain oxygen saturation, determined with a near-infrared oxygen monitor, and mean arterial pressure during surgery were calculated and compared among the 3 groups.Results: Patients who had undergone awake off-pump coronary artery bypass grafting with thoracic epidural anesthesia had a significantly higher cerebrovascular impairment ratio, and the EuroSCORE was high. No significant differences were observed among the 3 groups in terms of the relationship between mean arterial pressure during surgery and regional brain oxygen saturation. It is suggested that there were no differences in cerebral blood flow and mean arterial pressure changes among the 3 groups.Conclusions: Awake off-pump coronary artery bypass grafting is a safe surgical technique for patients with history of cerebral infarction or impaired cerebral blood flow. Awake off-pump coronary artery bypass grafting is a less invasive procedure that allows efficient management of intraoperative cerebral blood flow, and can be equally effective as a percutaneous coronary intervention.

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“…Further studies are required to verify the effectiveness of this technique and to determine the optimal dose of morphine, which provides adequate analgesia with minimal risk of respiratory depression that appears to be the most important side effect during the postoperative period. Awake OPCAB is a promising modality of minimally invasive cardiac anesthesia [83] which uses a combined femoral block/TEA [84] or spinal anesthesia/TEA [85] or TEA alone, associating local anesthetic infiltration if required for the vessel graft harvesting [86][87][88] [ Figure 3]. [83] Awake cardiac surgery might have some benefits, such as short ICU stay.…”

Section: Premedication and Monitoringmentioning

confidence: 99%

“…Awake OPCAB is a promising modality of minimally invasive cardiac anesthesia [83] which uses a combined femoral block/TEA [84] or spinal anesthesia/TEA [85] or TEA alone, associating local anesthetic infiltration if required for the vessel graft harvesting [86][87][88] [ Figure 3]. [83] Awake cardiac surgery might have some benefits, such as short ICU stay. Maintenance of spontaneous respiration avoids the disadvantages of mechanical ventilation and GA in high-risk patients.…”

Section: Premedication and Monitoringmentioning

confidence: 99%

Anesthesia for off-pump coronary artery bypass surgery

et al. 2013

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The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB) surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

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Awake coronary artery bypass grafting under thoracic epidural anesthesia: great impact on off-pump coronary revascularization and fast-track recovery

Cited by 16 publications

References 15 publications

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Monitoring brain oxygen saturation during awake off-pump coronary artery bypass

Anesthesia for off-pump coronary artery bypass surgery

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