Comparison of three anesthetic techniques for off-pump coronary artery bypass grafting: general anesthesia, combined general and high thoracic epidural anesthesia, or high thoracic epidural anesthesia alone.

Objective: This study compared general anesthesia (GA), combined GA plus thoracic epidural anesthesia (TEA), and TEA alone in patients scheduled for off-pump coronary artery bypass grafting.

Design: Prospective, nonrandomized clinical study

Setting: University hospital.

Participants: Ninety consenting patients undergoing beating-heart coronary artery revascularization with comparable coronary status and left ventricular function.

Operative techniques in awake coronary artery bypass grafting.

Background: Off-pump coronary artery bypass grafting was implemented to reduce trauma of surgical coronary revascularization by avoiding extracorporeal circulation. High thoracic epidural anesthesia further reduces intraoperative stress and postoperative pain. In addition, this technique even allows awake coronary artery bypass grafting, avoiding the drawbacks of mechanical ventilation and general anesthesia in high-risk patients.

Coronary artery bypass grafting via sternotomy in conscious patients.

The application of high thoracic epidural anesthesia (TEA) as an adjunct to general anesthesia is increasingly being used for coronary artery bypass grafting (CABG) with extracorporeal circulation. Recent developments in beating heart techniques rendered the sole use of TEA in conscious patients possible, and have been reported for single-vessel beating heart CABG via lateral thoracotomy. For multi-vessel revascularization, the heart is usually approached via sternotomy; therefore, the sole use of TEA was applied in awake patients who underwent CABG via sternotomy.

Awake coronary artery bypass grafting: utopia or reality?

Background: Off-pump coronary artery bypass grafting (OPCAB) was implemented to reduce trauma during surgical coronary revascularization. High thoracic epidural anesthesia further reduced intraoperative stress and postoperative pain. This technique also supports awake coronary artery bypass (ACAB), completely avoiding the drawbacks of mechanical ventilation and general anesthesia in high-risk patients.

Totally endoscopic bilateral internal thoracic artery bypass grafting in a young diabetic patient.

Background: The introduction of robotics into cardiosurgical practice in 1998 has enabled totally endoscopic closed chest procedures. Totally endoscopic grafting of the LAD (TECAB) is no longer an experimental procedure.

Case Report: We report on a case with totally endoscopic bilateral internal thoracic artery bypass grafting to the left anterior descending and right coronary artery in a 36-year-old obese female diabetic patient using the daVinci surgical system.