Thoracic Epidural Anesthesia as the Last Option for Treating Angina in a Patient Before Coronary Artery Bypass Surgery

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Abstract
Schemic cardiomyopathy in a patient with medi- cally refractory unstable angina is a difficult clinical scenario. Unfavorable anatomy and/or comorbid- ity can prohibit the safe performance of angioplasty or coronary artery bypass (CAB) surgery. Thoracic epi- dural anesthesia (TEA) has been used successfully to stabilize patients with unstable angina refractory to maximum medical therapy (1). TEA has also been used during and after CAB surgery in patients with preserved left ventricular function (2,3). We describe a patient with intractable angina, poor ventricular function, and complicated comorbidities who received TEA for angina, later underwent CAB surgery using TEA in combination with general anes- thesia, and continued to receive TEA for postoperative pain relief.