title: Brain function monitoring during off-pump cardiac surgery: a case report.
abstract: BACKGROUND
  Early postoperative stroke is an adverse syndrome after coronary bypass surgery. This report focuses on overcoming of cerebral ischemia as a result of haemodynamic instability during heart enucleation in off-pump procedure.
  
  
  METHODS
  A 67 year old male patient, Caucasian race, with a body mass index of 28, had a recent non-Q posterolateral myocardial infarction one month before and recurrent instable angina. His past history includes an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, epiaortic vessel stenosis. The patient was scheduled for an off-pump procedure and monitored with bilateral somatosensory evoked potentials, whose alteration signalled the decrement of the cardiac index during operation.The somatosensory evoked potentials appeared when the blood pressure was increased with a pharmacological treatment.
  
  
  CONCLUSIONS
  During the off-pump coronary bypass surgery, a lower cardiac index, predisposes patients, with multiple stroke risk factors, to a reduction of the cerebral blood flow. Intraoperative somatosensory evoked potentials monitoring provides informations about the functional status of somatosensory cortex to reverse effects of brain ischemia.
authors.affiliation: Anesthesia and Intensive Care Department, Treviso Regional Hospital, Piazzale Ospedale n degrees 1, 31100, Treviso, Italy. pzanatta@mac.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanatta
authors.forename: Enrico
authors.initials: E
authors.lastname: Bosco
authors.forename: Piero
authors.initials: P
authors.lastname: Di Pasquale
authors.forename: Agarwal
authors.initials: A
authors.lastname: Nivedita
authors.forename: Carlo
authors.initials: C
authors.lastname: Valfrè
authors.forename: Carlo
authors.initials: C
authors.lastname: Sorbara