Cerebral venous congestion during cardio-pulmonary bypass: role of bispectral index monitoring.
A 58-year-old male patient was posted for double valve replacement under hypothermic cardiopulmonary bypass (CPB). During aortic cross-clamp (AXC), the central venous pressure (CVP) was found to have increased to 22 mmHg. After 4 minutes of sustained increase in CVP, burst suppression (SR) started increasing. After 5 min of increase in SR, bispectral index (BIS) declined rapidly to 17. Propofol infusion was stopped and re-evaluation of signs of facial congestion showed changes to that effect. The perfusionist noted steadily decreasing venous return. As soon as the superior vena cava (SVC) cannula was withdrawn by 3 cm, CVP immediately declined to 6 mmHg. The venous return in the CPB reservoir normalized and BIS returned to 42 after a transient rise to a maximum of 58 and SR decreased to 0 within 2 min of repositioning of the venous cannula. The patient was successfully extubated after 7 hours without any sequelae.
Puri
Gd
G
Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India. gdpuri007@hotmail.com
Agarwal
J
J
Solanki
A
A
Rana
Ss
S
D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002496:Central Venous Pressure; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000209:etiology; D006350:Heart Valve Prosthesis; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*