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Bispectral index as an indicator of cerebral hypoperfusion during off-pump coronary artery bypass grafting
Thomas M Hemmerling1, Jean-François Olivier, Fadi Basile
1From the Perioperative Cardiac Research Group (PECARG), Departments of Anesthesiology and *Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Hôtel-Dieu, Université de Montréal, Montréal, Québec, Canada.
Insights
Bradycardia and hypotension are common during off-pump coronary artery bypass grafting (OPCAB). Bispectral index (BIS) monitoring may indicate reversible cerebral hypoperfusion during OPCAB surgery.
Area of Science:
- Cardiology
- Neurology
- Anesthesiology
Background:
- Off-pump coronary artery bypass grafting (OPCAB) is associated with hemodynamic instability, including bradycardia and hypotension.
- Cerebral hypoperfusion is a potential complication during OPCAB, posing risks to neurological function.
Observation:
- A case study involving a 58-year-old patient undergoing OPCAB presented with a sudden decrease in Bispectral Index (BIS) from 45-50 to 0 during distal grafting of the left circumflex artery.
- This sudden drop in BIS occurred concurrently with bradycardia and hypotension.
Findings:
- The patient experienced reversible global cerebral hypoperfusion, indicated by the significant drop in BIS.
- Immediate neurological evaluation post-surgery revealed no deficits, and the patient had an uneventful recovery and discharge.
Implications:
- Bispectral Index (BIS) monitoring can serve as a valuable indicator of cerebral hypoperfusion during OPCAB procedures.
- Early detection of cerebral hypoperfusion through BIS monitoring may allow for timely interventions to prevent neurological sequelae in patients undergoing OPCAB.
Abstract:
Bradycardia and hypotension are common during off-pump coronary artery bypass grafting (OPCAB). We present a case of possible reversible global cerebral hypoperfusion during distal grafting of the left circumflex coronary artery. The bispectral index (BIS) suddenly decreased from values of 45-50 to 0 during distal grafting. Neurologic evaluation after immediate tracheal extubation in the operating room was normal and the 58 yr old patient did not suffer any neurologic sequelae. Postoperative recovery was uneventful and the patient was discharged 5 days after surgery. Cerebral hypoperfusion is a possible complication during OPCAB. BIS monitoring in OPCAB could be an indicator of cerebral hypoperfusion.
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