title: Cannula malposition during antegrade cerebral perfusion for aortic surgery: role of cerebral oximetry.
abstract: OBJECTIVE
  To describe the use of cerebral oximetry to detect a lack of right cerebral perfusion resulting from a malpositioned catheter used for antegrade cerebral perfusion during deep hypothermic circulatory arrest (DHCA). The simple corrective surgical adjustment that followed averted a potentially serious complication.
  
  
  METHODS
  A 57-yr-old male with a type-A aortic dissection undergoing DHCA required antegrade cerebral perfusion for cerebral protection. Catheters were placed accordingly in the left common carotid and brachiocephalic arteries. Whereas frontal cerebral oximetry immediately improved on the left, it did not improve on the right. It was immediately suspected that the tip of the brachiocephalic cannula had advanced into the right subclavian artery, thus depriving the right common carotid artery of blood flow. The problem resolved upon slight withdrawal of the cannula.
  
  
  CONCLUSIONS
  Vigilance in anesthesia should not stop during DHCA or cardiopulmonary bypass. Cerebral oximetry may provide important information leading to actions that improve brain protection. Vigilances proved important in this case where the cannula tip used for antegrade cerebral perfusion was advanced too far into the right subclavian artery.
authors.affiliation: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
authors.forename: Simon K C
authors.initials: SK
authors.lastname: Chan
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Underwood
authors.forename: Anthony M-H
authors.initials: AM
authors.lastname: Ho
authors.forename: Jack M
authors.initials: JM
authors.lastname: So
authors.forename: Adrienne K
authors.initials: AK
authors.lastname: Ho
authors.forename: Innes Y P
authors.initials: IY
authors.lastname: Wan
authors.forename: Randolph H L
authors.initials: RH
authors.lastname: Wong
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001921:Brain / Q000378:metabolism*; D057785:Catheters / Q000009:adverse effects*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D013348:Subclavian Artery