Thoracic epidural anesthesia for off-pump coronary artery bypass grafting in a spontaneously breathing conscious patient.

Minimally invasive coronary artery surgery is nowadays considered a safe surgical strategy. We report a case of a 70-year-old man with a high operative risk who underwent off-pump coronary artery bypass grafting using only high thoracic epidural anesthesia without intubation. The patient well tolerated each phase of the operation. The effect of the movement of the chest wall and the heart during spontaneous respiration did not influence the conduction of the operation. The postoperative course of the patient was uneventful. At follow-up the patient was asymptomatic. Repeat coronary arteriography and echocardiography respectively confirmed the patency of the anastomoses and the improvement of the left ventricular performance. In carefully selected cases thoracic epidural anesthesia for off-pump coronary artery bypass grafting in spontaneously breathing conscious patients is feasible and may offer many benefits.