European Journal of Cardiovascular Medicine

Coronary artery bypass grafting (CABG) is the most commonly performed procedure in most of the  cardiac centres. Patients with ischemic heart disease often suffer from other co-morbidities like  hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), chronic kidney disease  or cerebrovascular disease. Hence, optimising the patient pre-operatively is essential to decrease the  intra-operative risk factors and increase the chances of faster recovery in the post operative days. Based  on the associated co-morbidities, surgical and anaesthetic techniques have to be modified to suit  individual patient’s needs. Severe restrictive airway disease, pulmonary fibrosis and chronic pulmonary  infections will benefit with the use of high thoracic epidural anaesthesia (TEA) instead of endotracheal  general anesthesia which is the norm for any CABG procedure. In order to overcome post operative  lung complications and a possible ventilatory dependency in such cases, awake CABG is performed as  a suitable alternative to the conventional procedure.