Awake off-pump coronary bypass allows speedy recovery, less pain

By Joene Hendry

NEW YORK (Reuters Health) – Patients undergoing off-pump coronary artery bypass surgery while awake recover faster and report less postoperative pain than patients undergoing the same procedure under general anesthesia, according to data presented Thursday during the Cardiothoracic Techniques and Technologies 2002 meeting in Miami Beach, Florida.

"Awake coronary artery bypass surgery brings surgical revascularization closer to interventional therapy than any other technique in heart surgery," Dr. Tayfun Aybek of Johann Wolfgang Goethe University in Frankfurt, Germany told Reuters Health.

Dr. Aybek and colleagues performed coronary artery bypass surgery in 25 patients who were awake but receiving regional anesthesia via a thoracic epidural catheter that had been placed 1 day prior to surgery. Seventeen of the patients underwent partial lower ministernotomy, seven had double bypass grafting and one patient had triple vessel grafting.

The researchers compared outcomes from the awake cohort with those of 28 patients matched for age, gender and comorbidities who were undergoing either left anterior minithoracotomy or complete sternotomy off-pump surgery while under general anesthesia.

Dr. Aybek noted an average procedure time of 73 minutes in the awake surgical group compared with 99 minutes for the group that had standard off-pump bypass surgery under general anesthesia. The awake patients did not require time in the intensive care unit and spent an average of just 4.4 hours in intermediate care. This compares with an average intensive care unit stay of 16 hours for the anesthetized, he reported.

Twenty-two patients remained awake throughout surgery while three patients in the awake group required secondary intubation, one for incomplete analgesia and two for pneumothorax.

The awake procedure does not require that patients undergo mechanical ventilation and avoids the complications of general anesthesia, Dr. Aybek pointed out. This permits "better and faster recovery and less post-op pain."

Early postoperative pain scores were significantly lower in the awake group compared with controls, Dr. Aybek said. He reported post-surgical same day activity in 14 of 25 patients in the awake group compared with 3 of 28 patients in the control group.

The investigators noted improved pain control and mobilization when thoracic epidural analgesia was continued for 3 days post-op in the awake patients.

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