Combined carotid endarterectomy and off-pump coronary artery bypass surgery under thoracic epidural anesthesia without endotracheal general anesthesia.

摘要

WITH THE INCREASING age of patients undergoing coronary artery bypass graft (CABG) surgery, a greater number of patients have associated clinically significant carotid artery disease and this results in a dilemma regarding the best surgical management. The incidence of cardiac morbidity and mortality in patients who undergo carotid artery surgery ranges from 0.7% to 7.1% and still represents almost 50% of all perioperative complications. These complications have even greater significance in patients who undergo combined CABG surgery and carotid endarterectomy (CEA). The greatest risk in CEA is of neurologic complications (usually <6%); however, the risk of myocardial infarction is <4%.General anesthesia is most comfortable for the patient and the surgeon during CEA, but regional anesthesia has been shown by some authors to be superior. Previously, the benefits of regional anesthesia could not be obtained during CABG because it was not deemed possible to perform off-pump coronary artery bypass (OPCAB) surgery until recently. Regional anesthesia (cervical nerve block or cervical epidural anesthesia) can be reliably monitored while therapeutic maneuvers such as carotid unclamping, placement of an intracarotid stent, and increasing of arterial pressure are performed.