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Though Indian surgeon has done hundreds of cases, technique hasn't moved beyond pilot stage in Canada
BANGALORE, INDIA | Conversing with a patient while cutting his chest open and operating on his heart may seem an unlikely scenario, but its all in a day's work for Dr. Vivek Jawali at the Fortis Hospital here.
As of mid- February, the cardiac surgeon had done 512 procedures with the patient awake, 183 of them employing cardiopulmonary bypass so the heart could be stopped.
In an e-mail interview with the Medical Post, Dr. Jawali said he began performing awake cardiac surgery in 1998 to aid fast- tracking of patients and to reduce pulmonary complications.
The technique employs high thoracic epidural anesthesia and, he said, is best suited for patients who have no severe ventricular dysfunction or pulmonary hypertension, and no anatomical difficulties for introduction of the epidural catheter. He said 19 cases had to be converted to general anesthesia, but there have been no major complications. Patients who panic during surgery get an extra dose of midazolam.
Canadian experience
For Dr. Nicolas Noiseux, a cardiac surgeon and associate professor of surgery at the Hôtel- Dieu Hospital...