HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gino Gerosa Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gerosa, G. Articles by Marco, F. d. Search for Related Content PubMed PubMed Citation Articles by Gerosa, G. Articles by Marco, F. d. Related Collections Anesthesia Cardiac - other Coronary disease Great vessels

Eur J Cardiothorac Surg 2005;27:168-170
© 2005 Elsevier Science NL

Case report

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

^a Department of Cardiovascular Surgery-Padua University Medical School, Padova, Italy
^b Department of Anaesthesiology and Pharmacology, Unit of Anaesthesia and Intensive Care-Padua University Medical School, Padova, Italy
^c Department of Medical and Surgical Science, Division of Vascular Surgery-Padua University Medical School, Padova, Italy

Received 26 July 2004; received in revised form 5 October 2004; accepted 15 October 2004.

^* Corresponding author. Address: Istituto di Chirurgia Cardiovascolare Centro V. Gallucci-Policlinico-Via Giustiniani 2, 35128 Padova, Italy. Tel.: +39 498 212 412;fax: +39 0498 212 409. (E-mail: gino.gerosa{at}unipd.it).

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, mantained above 10g/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.

Key Words: Jehowa witness • Awake surgery • Coronary artery bypass • Carotid endarterectomy