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Eur J Cardiothorac Surg 2004;26:1228-1229
© 2004 Elsevier Science NL

Letter to the Editor

Epidural anesthesia for coronary artery bypass surgery

Gianluigi Bisleria,*, Tomaso Bottioa, Aldo Manzatob, Claudio Munerettoa

a Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
b Section of Cardiothoracic Anesthesia, Spedali Civili di Brescia, Brescia, Italy

Received 16 August 2004; accepted 20 August 2004.

* Corresponding author. Address: UDA Cardiochirurgia, Spedali Civili, P.le Spedali Civili, 1, 25123 Brescia, Italy. Tel.: +39 030 399 6401; fax: +39 030 399 6096. (E-mail: gianluigi_bisleri{at}katamail.com).

We read with interest the report by Dr Lucchetti and colleagues [1] about the use of a combined high-thoracic epidural and lumbar subarachnoid block in a patient undergoing off-pump myocardial revascularization. Nevertheless, the present report raises some concerns with respect to several issues: first, in the article the authors state that this innovative anesthesiological technique is extremely useful in a population of high-risk patients, especially those with impaired pulmonary function. However, it is questionable if the patient described entered those criteria, since no specific data are reported about the respiratory functional tests and accordingly to the brief description of the past medical history, the patient is unlikely to be at ‘high-risk’. Additionally, the advantages of total arterial myocardial revascularization have been demonstrated in several reports, especially in the elderly [2,3]; therefore, it is also questionable the reason of using saphenous grafts, especially in a case where an additional risk maneuver (i.e. lumbar subarachnoid block) is required. Conversely, in our experience with CABG surgery in the awake patients we routinely use the radial artery as an alternative to the saphenous grafts and no additional block is required since the high-thoracic epidural analgesia itself allows a painless harvesting of the radial artery.

We conclude that CABG surgery is feasible in awake patients when a high-thoracic block is performed, and total artery revascularization by using bilateral thoracic arteries combined with radial artery allows the best results reducing the potential risks related to the need of an additional lumbar block.

Footnotes

☆ The authors of the original paper [1] were invited to comment on this Letter to the Editor but declined the offer.

References

  1. Lucchetti V, Moscariello C, Catapano D, Angelini GD. Coronary artery bypass grafting in the awake patient: combined thoracic epidural and lumbar subarachnonid block. Eur J Cardiothorac Surg 2004;26:658-659.[Abstract/Free Full Text]
  2. Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R, McCarthy PM, Cosgrove DM. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 1999;117:855-872.[Abstract/Free Full Text]
  3. Muneretto C, Negri A, Bisleri G, Manfredi J, Terrini A, Metra M, Nodari S, Dei Cas L. Is total arterial myocardial revascularization with composite grafts a safe and useful procedure in the elderly?. Eur J Cardiothorac Surg 2003;23:657-664.[Abstract/Free Full Text]




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