Simultaneous coronary artery bypass grafting and carotid endarterectomy in an awake Jehova's witness patient without endotracheal intubation

Abstract

Complex surgical procedures are associated with a major risk of peri-operative bleeding. Jehova's witnesses (JW) necessitate a tailored strategy warranting the optimal surgical management, in observance to their religion principles. In this report, we present a JW female patient, who underwent combined coronary artery bypass grafting and carotid endarterectomy, with neither endotracheal intubation nor general anaesthesia. Patient had previously undergone bilateral endarterectomy and required a reoperation on the left side. She was also scheduled for revascularization of left anterior descending coronary artery. After an extensive evaluation of all the possible operative strategies, we planned to perform CABG via a mid-line sternotomy, followed by CEA, in the awake patient. There were no intra-operative complications. Hb level, monitored by blood gases controls, maintained above 10 g/dl. The post-operative course was uneventful. In this patient, for the first time, a high-risk CABG procedure and a high-risk CEA were carried out simultaneously, in the awake setting. This approach represented a meeting point between surgical requirements and specific patient's needs. We believe it could be a safe alternative management applicable to high risk candidates to combined carotid and coronary artery surgery, presenting with bleeding-related issues.

Complex liver resection for a large intrahepatic cholangiocarcinoma in a Jehovah's witness: A strategy to avoid transfusion

“…Chronic shortages of donated blood, the risk of transmission of blood-borne diseases [8,9], the immunosuppressive effect of transfusion on cancer patients [10], and the overall cost of transfusion have stimulated surgeons around the world to develop methods for transfusion-free surgery. Recent studies have shown that major operations such as liver transplantation and coronary artery bypass grafting can be performed successfully in Jehovah's Witnesses when blood augmentation and blood conservation techniques are used [1,11].…”

Coronary artery bypass and carotid endarterectomy with mild hypothermia

“…Stenting before CABG has been successfully performed by some centers; the limitation is that it is not applicable in unstable patients because of the necessity of a 1-month interval of antiplatelet therapy between the 2 procedures and the increased risk of MI. 14 Meharwal and colleagues 15 reported the results of 82 patients who had combined off-pump coronary artery bypass grafting and carotid endarterectomy. They reported no hospital mortality, no stroke, one transient neurologic deficit, and one temporary 12 th nerve dysfunction.…”

Koronare Bypasschirurgie am wachen Patienten

“…Darüber hinaus existiert ein Fallbericht über die koronare Bypassoperation in Epiduralanästhesie mit anschließender Karotisdesobliteration, die mithilfe eines Zervikalblocks durchgeführt wurde [22]. Kritisch sind bei derartigen, kombinierten regionalanästhesio-logischen Verfahren einerseits die potenziellen Kreislaufreaktionen auf eine plötz-liche Sympathikolyse während der Spi- nalanästhesie, andererseits auch die relativ hohen Mengen an Lokalanästhetika, die für periphere Nervenblockaden benö-tigt werden, zu bewerten.…”

“…k.A. Lucchetti et al [44] MS (n=1) LIMA+ACVB RIVA+RCX Hemmerling et al [26] MS (n=2) LIMA+ACVB RIVA+RCX Gerosa et al [22] MS (n=1) LIMA RIVA Noiseux et al [53] MS (n=15)…”

“…Obwohl vereinzelt über ein gutes Outcome schwerst vorerkrankter Patienten nach ACAB-Operationen berichtet wurde, liegen auch hierzu keine Vergleichsdaten zu anderen chirurgischen und anästhesiologischen Techniken vor. Karagoz [22]. Als eindeutig von Nachteil muss jedoch nach gegenwärtiger Datenlage der Wegfall der kardioprotektiven Effekte volatiler Anästhetika bei ACAB-Eingriffen in alleiniger Regionalanästhesie bewertet werden.…”