AWAKE CArdIAC surGEry: WHErE dOEs IT sTAnd TOdAy?

The technique of Awake coronary artery bypass (ACAB ) is about seven years old, it was first reported by Karagoz and coworkers. They performed few successful cardiac surgeries using thoracic epidural anestehsia in an awake patients without endotracheal general anesthesia.. After the initial reports, several authors reported series of cases, totaling to about one thousand cases so far. Ever since the first report, the topic of awake cardiac surgery has remained controversial, because purists argued against the use of regional anesthesia as the sole anesthetic. The author among the other pioneers of the technique has faced questions about the usefulness of this procedure. Having performed about six hundred cardiac surgical cases, the author is of the opinion that at certain situations in one’s anesthetic practice, patients who are contra indicated for administration of general anesthesia (GA) may benefit from the regional anesthetic technique. The author has anesthetized patients (with myasthenia gravis, tracheal stenosis, multiple organ dysfunctions including hepatic and renal dysfunction) who may have carried higher risk with administration of GA . The author believes that the technique of awake surgery has to be practiced step by step. The first step being routine administration of thoracic epidural anesthesia in cardiac surgical population, thus increasing the total number of epidurals in cardiac surgical patients. With this action, the controversy about use of epidural anesthesia in cardiac surgical patients will be settled to some extent. One may debate about the benefits of ACAB by eliciting the risks and benefits of TEA and GA