Awake Off-pump Coronary Artery Bypass Grafting with Thoracic Segmental Spinal Anesthesia: Initial Experience in Three Patients

Export Awake off-pump coronary artery bypass grafting (OPCAB) is an alternative surgical approach in patients where general anesthesia is considered high-risk or contraindicated. Thoracic segmental spinal anesthesia, although rarely reported as a sole anesthetic technique in cardiac surgery, offers the potential to avoid airway instrumentation, mechanical ventilation, and associated complications. We report a series of three high-risk patients undergoing single-vessel OPCAB under thoracic spinal anesthesia. The patients presented with either advanced pulmonary disease, anticipated difficult airway, or severe obesity, rendering general anesthesia and tracheal intubation unsafe. In all three cases, awake surgery was performed without sedation, intubation, or opioid administration. Hemodynamic stability was maintained throughout the procedures, and postoperative recovery was uneventful with effective pain control. This case series demonstrates the feasibility and safety of thoracic segmental spinal anesthesia as a standalone anesthetic technique in selected high-risk patients undergoing cardiac surgery.