Awake Thoracic Surgery with Thoracic Epidural Anesthesia in High-Risk Patients: Three Case Reports and Clinical Insights
Year: 2025
Type: article
Study design: Case Report
Abstract: T horacic epidural anesthesia (TEA), initially described by Crawford et al. [1] in 1952, has been a well-established adjunct to general anesthesia in thoracic surgery.Despite its long history, the use of TEA as the sole anesthetic technique for major thoracic procedures has been limited, es-pecially after the advent of the double-lumen tube and one-lung ventilation (OLV) technique.This conservative approach is largely due to the traditional reliance on general anesthesia to facilitate lung deflation and double-lumen tube insertion, which are believed to be essential for Awake thoracic surgery utilizing thoracic epidural anesthesia has shown significant advantages over general anesthesia, especially in patients with comorbidities.This case report presents three cases of critically ill patients who successfully underwent awake thoracic surgery using thoracic epidural anesthesia.The first case involved an 81-year-old male with advanced chronic obstructive pulmonary disease who underwent thoracotomy with decortication for mesothelioma.The second case involved a 73-year-old male with a history of hypertension, coronary artery bypass graft surgery, laryngeal cancer, and permanent tracheostomy who underwent videoassisted thoracic surgery for alung tumor.Finally, the third case involved a 41-year-old female with a history of hypertension, tuberous sclerosis, epilepsy, and interstitial lung disease.All patients were managed with epidural anesthesia and conscious sedation, resulting in perioperative hemodynamic stability and effective pain control without the need for additional opioids.These cases highlight the efficacy and safety of thoracic epidural anesthesia for facilitating pain-free, uneventful thoracic surgeries in high-risk patients, suggesting that thoracic epidural anesthesia is a viable alternative to general anesthesia in selected cases.
Author: Sevgi Kesici
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4411931022