Awake Thoracic Surgery with Thoracic Epidural Anesthesia in High-Risk Patients: Three Case Reports and Clinical Insights

Our plain-English summary of Awake Thoracic Surgery with Thoracic Epidural Anesthesia in High-Risk Patients: Three Case Reports and Clinical Insights, by S. Kesici, F. Uysal, N.B. Sancak, et al (Şişli Etfal Hastanesi Tıp Bülteni, 2025).

The study

• Authors: S. Kesici, F. Uysal, N.B. Sancak, C. Kaya, O. Derdiyok, U. Temel, A.S. Cinar, S. Oba
• Journal: Şişli Etfal Hastanesi Tıp Bülteni
• Published: 2025;59(2):244-247
• Read it: PubMed · Publisher · Free full text

Abstract

Awake thoracic surgery utilizing thoracic epidural anesthesia has shown significant advantages over general anesthesia, especially in patients with comorbidities. This case report presents three cases of critically ill patients who successfully underwent awake thoracic surgery using thoracic epidural anesthesia. The first case involved an 81-year-old male with advanced chronic obstructive pulmonary disease who underwent thoracotomy with decortication for mesothelioma. The second case involved a 73-year-old male with a history of hypertension, coronary artery bypass graft surgery, laryngeal cancer, and permanent tracheostomy who underwent video-assisted thoracic surgery for alung tumor. Finally, the third case involved a 41-year-old female with a history of hypertension, tuberous sclerosis, epilepsy, and interstitial lung disease. All patients were managed with epidural anesthesia and conscious sedation, resulting in perioperative hemodynamic stability and effective pain control without the need for additional opioids. These cases highlight the efficacy and safety of thoracic epidural anesthesia for facilitating pain-free, uneventful thoracic surgeries in high-risk patients, suggesting that thoracic epidural anesthesia is a viable alternative to general anesthesia in selected cases.

© Copyright 2025 by The Medical Bulletin of Sisli Etfal Hospital.

In plain English

This article is a case report from Türkiye about three high-risk patients, all rated ASA IV, who had chest surgery while awake. Instead of general anesthesia, they received thoracic epidural anesthesia, a numbing catheter placed in the upper back at the T4-T5 level, with conscious sedation. The first patient was an 81-year-old man with advanced chronic obstructive pulmonary disease. He had a thoracotomy with decortication because of mesothelioma. The article does not state the site of the mesothelioma or mention asbestos exposure. The second was a 73-year-old man with a permanent tracheostomy after laryngeal cancer. He had a video-assisted lingula resection for a lung tumor. The third was a 41-year-old woman who had surgery for a left pneumothorax. The authors reported that all three stayed hemodynamically stable during surgery, needed no additional opioids, had pain scores below 3, and were discharged shortly afterward without complications. The authors concluded that the technique is a viable alternative to general anesthesia in selected cases. The report describes what happened to these three individuals. It does not report how often such outcomes occur in a larger group, and it does not compare them with patients given general anesthesia.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (three cases)
• Who was studied: Three high-risk (ASA IV) surgical patients in Türkiye: an 81-year-old man with advanced COPD and mesothelioma, a 73-year-old man with a lung tumor and a permanent tracheostomy after laryngeal cancer, and a 41-year-old woman with a left pneumothorax
• Exposure: No asbestos exposure, fiber type or occupation is described for any patient. The article concerns an anesthetic technique: thoracic epidural anesthesia through a catheter at T4-T5 (bupivacaine, lidocaine and fentanyl), with conscious sedation, during awake chest surgery.
• Main results:
  • Case 1 (81-year-old man) underwent surgery because of mesothelioma (thoracotomy with decortication); the site of the mesothelioma is not specified
  • Case 2 (73-year-old man with tracheostomy) had an awake video-assisted left lingula resection under thoracic epidural anesthesia
  • Case 3 (41-year-old woman) had surgery for left pneumothorax
  • All three patients kept stable heart and blood pressure measurements during surgery
  • No additional opioids were given to any of the three patients during surgery
  • Perioperative visual analog pain scores were less than 3 for all three patients
  • All three were discharged shortly after surgery without complications
• The authors' conclusion: The authors concluded that thoracic epidural anesthesia for awake surgery is a viable alternative to general anesthesia in selected high-risk patients

Topics

Medical terms in this study, explained in our Lexicon: Thoracic Surgery, Thoracotomy, Mesothelioma, Laryngeal Cancer, Interstitial Lung Disease.

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