72-year-old with unfit lungs has rare awake bypass operation in Nagpur

NAGPUR: A 72-year-old man underwent a rare awake bypass surgery at a private hospital in the city after his lungs were found unfit for general anaesthesia.
Generally, patients with chronic obstructive pulmonary disease (COPD) or asthma are advised against a cardiac surgery because of the slim chances of lung reactivation after operation. In this therapy, only the thoracic part of the part was numbed.
The patient was a retired mine worker and had highly compromised lungs because of chronic bronchitis. The routine open heart surgery would have required putting him on complete mechanical ventilator support, involving high risk.
“It may have been difficult to wean him off ventilator because of his poor lung health. This left the only option of awake surgery using thoracic epidural analgesia,” said Dr Vivek Lanje, cardio-vascular thoracic surgeon at Kims Kingsway hospital.
The patient was detected with two blockages five years ago, as per Dr Shaliendra Ganjewar, cardiologist at the hospital. “As bypass was not possible in his case, we had done angioplasty. He was on blood thinners for sometime but during Covid he stopped the drugs.
“Later, he developed three new blockages. So, this time we planned bypass instead of angioplasty as we have new expertise and equipment,” he said.
Dr Manish Sonkusle, cardiac-anaesthetist, said the man’s spinal nerves were blocked to paralyse the thoracic area. “He was sedated but not completely knocked down. A catheter was inserted in his spine and local anaesthesia given. The patient could move his limbs, talk and remain awake but couldn’t feel pain when his chest was cut open,” he said.
Dr Ganjewar said the patient recovered very fast. “This is a new kind of anesthesia therapy. It is not recommended for all patients but only for those with bad lungs,” he said. Dr Santosh Mankar, Dr Vijaya Lanje, Dr Samir Lote and Dr Kalyani Sonkar were part of the team.