Awake epidural anesthesia is effective and safe in the high-risk colectomy patient

PURPOSE: This study was designed to examine the feasibility and safety of performing open colectomy using awake epidural anesthesia in high-risk patients with comorbid illnesses. METHODS: We retrospectively compared 15 highrisk patients who underwent colectomy using awake epidural anesthesia with 17 lower risk colectomy patients who received conventional general endotracheal anesthesia. All patients were operated on consecutively during the same time period by the same surgeon. RESULTS: Based on the number of coexisting diseased organ systems and by a weighted multifactorial index of operative risk, the patients receiving awake epidural anesthesia were significantly more ill than the patients receiving general anesthesia. No differences in complications, length of operative procedure, or number of lymph nodes in cancer specimens were found between the two groups. There was a trend favoring the epidural technique when operative blood loss, length of postoperative hospital stay, and return of bowel function were considered. CONCLUSIONS: Awake epidural anesthesia is a safe and effective technique in high-risk patients undergoing colectomy and achieves an operative risk that compares favorably with healthier patients receiving general anesthesia.