[Brain protection with mild hypothermia during carotid artery clamping]

A 71-year-old man was scheduled for removal of a Kirchner wire malpositioned in the mediastinum, which had been placed for fixing the fractured right clavicle five months before. Anesthesia was induced and maintained with propofol, fentanyl and vecuronium. The wire was found to be penetrating the brachiocephalic artery after sternotomy. An emergency angiography performed in the operating room showed that Willis arterial circle was sufficiently developed for clamping the brachiocephalic artery. The wire was removed under clamping the brachiocephalic artery for 9 minutes, but massive bleeding from the left common carotid artery continued, then the left common carotid artery was clamped and injured region was resected and reconstructed for 68 minutes. The body temperature was reduced to 32.5-33 degree with a cooling water mattress for brain protection and prostaglandin E1 was infused for vasodilation during hypothermia. Monitoring with somatosensory evoked potential was added during anesthesia. The surgery was performed uneventfully and the patient showed no neurological sequelae postoperatively.