A marked decrease in bispectral index with elevation of suppression ratio by cervical haematoma reducing cerebral perfusion pressure.
A 77-year-old man with a ruptured abdominal aortic aneurysm undergoing aneurysmectomy were anaesthetised with ketamine under bispectral index (BIS) monitoring, which is a clinical EEG monitor for measurement of depth of anaesthesia/sedation. First marked BIS reduction with elevation of suppression ratio (SR) was observed following severe hypotension by deflation of the aortic occlusion balloon. The re-inflation and rapid blood transfusion improved haemodyanamics and BIS and SR. At second marked BIS reduction with SR elevation, a heavy cervical swelling due to a massive subcutaneous haematoma around the previously mis-punctured right carotid artery extending throughout the whole neck was observed without hypotension. Cervical relief incision improved the BIS and SR. The present case suggests that BIS monitor may be a simple and convenient monitor for cerebral ischaemia detection.
Department of Anesthesiology, School of Medicine, University of Hirosaki, Hirosaki, Japan.
N
N
Umegaki
K
K
Hirota
M
M
Kitayama
Y
Y
Yatsu
H
H
Ishihara
A
A
Mtasuki
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000473:pathology / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D002277:Carcinoma / Q000150:complications; D020212:Carotid Artery Injuries / Q000150:complications*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D004632:Emergency Medical Services / Q000379:methods; D017809:Fatal Outcome; D006406:Hematoma / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D006470:Hemorrhage / Q000150:complications / Q000601:surgery; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007601:Jugular Veins / Q000293:injuries; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000592:standards; D009333:Neck / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D019838:Neck Injuries / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D019736:Prostheses and Implants; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000150:complications