Awake Thoracic Surgery with Thoracic Epidural Anesthesia in High-Risk Patients: Three Case Reports and Clinical Insights

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 video-assisted 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.