Conscious Cardiac Surgery With Cardiopulmonary Bypass Using Thoracic Epidural Anesthesia Without Endotracheal General Anesthesia

Chakravarthy, Murali; Jawali, Vivek; Patil, TA; Krishnamoorthy, Jayaprakash; Kolar, Srinivasan; Joseph, G; Das, Jayant Kumar; Maheswari, Uma; S, Sudhakar N

doi:10.1053/j.jvca.2005.03.005

Cited by 17 publications

(5 citation statements)

References 16 publications

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“…1 Myriad anesthetic techniques have been studied for patients undergoing OPCAB, ranging from HTEA with endotracheal tube (ETT) to only HTEA in conscious patients. 3…”

Section: Current Scenariomentioning

confidence: 99%

“…The anesthetic approaches that have been developed and utilized over period of time for patients undergoing OPCAB are general anesthesia (GA) with opioids and inhalation anesthesia; GA combined with controlled ventilation and HTEA; GA combined with intrathecal opioids; awake regional anesthesia with spontaneous ventilation using HTEA alone; total intravenous anesthesia (TIVA) with ETT; and TIVA with laryngeal mask airway (LMA). [3][4][5][6][7] Scientific evidence and practical experience make TIVA the recommended choice for cardiac surgery (►Fig. 1).…”

Section: Anesthetic Approaches In Opcabmentioning

confidence: 99%

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Fast Tracking in Off Pump CABG with Supraglottic Airway and TIVA

Shah

2021

Journal of Cardiac Critical Care TSS

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The standard goals of anesthetic management for an off pump coronary artery bypass (OPCAB) surgery are that it should be safe, provide cardiac and other organ protection and stability, preserve neurocognitive integrity, maintain hemodynamics, allow early emergence and ambulation, and offer pain relief in the postoperative period. The cardiac surgical team should collaborate and plan the best preoperative strategy, so as to provide optimal care and a rapid and expeditious recovery of these patients. Scientific evidence and practical experience make total intravenous anesthesia (TIVA) the recommended choice for cardiac surgery. Use of endotracheal tube (ETT) is associated with certain drawbacks which can be overcome with judicious use of ProSeal laryngeal mask airway (PLMA) for cardiac surgeries too. The core principles of ultrafast track anesthetic (UFTA) technique are choice and titration of short-acting anesthetic drugs, postoperative normothermia, multimodal analgesia, early extubation, ambulation, and discharge. Fast tracking with use of TIVA and PLMA in patients undergoing OPCAB at our center offers certain advantages over other techniques in terms of reduced airway and lung trauma, improved cardiac output and renal perfusion with spontaneous respiration, decreased stress and discomfort of ETT suctioning and weaning from ventilation, substantially reduced requirement of dosages of analgesics, anesthetics and opioids, resulting in better patient hemodynamics, alert and pain-free patient that are more amenable and cooperative for early feeds, postoperative chest physiotherapy and lung recruitment strategies, and early ambulation and discharge.

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“…1 Myriad anesthetic techniques have been studied for patients undergoing OPCAB, ranging from HTEA with endotracheal tube (ETT) to only HTEA in conscious patients. 3…”

Section: Current Scenariomentioning

confidence: 99%

Section: Anesthetic Approaches In Opcabmentioning

confidence: 99%

Fast Tracking in Off Pump CABG with Supraglottic Airway and TIVA

Shah

2021

Journal of Cardiac Critical Care TSS

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“…The management of spontaneous ventilation in patients who undergo awake cardiac surgery, especially in those who undergo CPB, is still not well defined [4]. Continued or unexpected spontaneous ventilation during CPB interrupts the surgical procedure, in particular MICS, which requires a highly skilled surgeon and a limited operative field.…”

Section: Commentmentioning

confidence: 99%

“…Continued or unexpected spontaneous ventilation during CPB interrupts the surgical procedure, in particular MICS, which requires a highly skilled surgeon and a limited operative field. Chakravarthy and colleagues [4] reported a unique phenomenon in which inspiratory efforts decrease 1 to 2 minutes after CPB begins, culminating in apnea. Our patient also experienced apnea following the initiation of CPB.…”

Section: Commentmentioning

confidence: 99%

Minimally Invasive Awake Mitral Valve Surgery and Cardiopulmonary Bypass Without General Anesthesia

Kanda

Kamiya

Sugawara

et al. 2019

The Annals of Thoracic Surgery

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“…General anesthesia with full median sternotomy is the standard approach for aortic root surgery, and transesophageal echocardiography is mandatory in cases of aortic valve-sparing procedures. Awake cardiac surgery offers several advantages over general anesthesia, including the absence of tracheal intubation, reduced stress response, lower postoperative arrhythmias, and improved pulmonary outcome [24][25][26]. This approach may be more beneficial and safer in patients with chronic obstructive pulmonary disease who are frequently rejected for cardiac surgery [27,28].…”

Section: The Modified Bentall Technique Eliminates Wrapping Of the Namentioning

confidence: 99%

Isolated Aortic Root Aneurysms

Kırali¹,

Günay²

2017

Aortic Aneurysm

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The aortic root has a complex anatomy due to a combination of several anatomical structures based on simple and consistent work in it. It is a hollow cylinder with three bulges, which have the main functional effect on the aortic valve opening-closing cycle and coronary circulation. Aneurysm is defined as a dilation of a blood vessel segment having ≥50% increase in diameter, whereas annuloaortic ectasia represents a diffuse dilation <50% of the normal diameter of the related vessel segment. Aortic root aneurysms mostly occur by degenerative processes as compared with primarily atherosclerotic changes in the descending and abdominal aortas: medial fragmentation, smooth muscle cells necrosis, and elastic fiber fragmentations with cystic spaces in the media filled with mucoid material. Because of the elevated mortality risk associated with complications, an effective aortic root aneurysm management depends on reduction the risk of death, rupture, and dissection. Conventional open heart surgery is the essential procedure for isolated aortic root replacement and a type of procedure (valve replacement or sparing) could be selected due to the pathology. An extensive aortic root replacement technique is the only option to rebuild the left ventricular outflow tract due to the reconstruction of the neo aortoventricular continuity in the aortic root abscess.

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Conscious Cardiac Surgery With Cardiopulmonary Bypass Using Thoracic Epidural Anesthesia Without Endotracheal General Anesthesia

Cited by 17 publications

References 16 publications

Fast Tracking in Off Pump CABG with Supraglottic Airway and TIVA

Fast Tracking in Off Pump CABG with Supraglottic Airway and TIVA

Minimally Invasive Awake Mitral Valve Surgery and Cardiopulmonary Bypass Without General Anesthesia

Isolated Aortic Root Aneurysms

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