Background: Recently, awake coronary artery bypass graft (ACAB) with spontaneous ventilation has been performed under thoracic epidural anesthesia (TEA) without general anesthesia. We report our first experiences of 12 cases of ACAB with full median sternotomy under TEA.

METHODS: Between March and September 2005, 12 patients underwent ACAB under TEA. The thoracic epidural catheter was placed at the level of T1 and/or T8 vertebral body according to surgical plan. Seven to fifteen milliliter of 2% lidocaine and sufentanil 1.66µ/ml was administered through the epidural catheter.

RESULTS: There were 11 male and 1 female patients, aged 67 ± 7 years. In 10 (83.3%) patients, pneumothorax was observed during surgical intervention. During the operation, 5 patients needed to be received general anesthesia because of respiratory distress caused by pneumothorax (n = 3), bowel protrusion (n = 1) or bleeding (n = 1). Mean length of stay in intensive care unit and hospital stay were 1.5 ± 1.2 days and 6.3 ± 1.7 days, respectively.

CONCLUSIONS: Our initial experience confirms the feasibility of performing ACAB under TEA. However, high rate of conversion to general anesthesia and development of pneumotorax should be considered. Therefore, the actual and potential risks of ACAB under TEA should not be underestimated.